Health: Doctors get help to make life and death decisions

Two out of three babies and children who die in paediatric intensive care do so after treatment is withdrawn. Yesterday, the Royal College of Paediatrics and Child Health issued guidelines to help doctors and parents make these agonising decisions. Jeremy Laurance, Health Editor, investigates.

Desperately ill children who would never have survived a decade ago can now be kept alive as a result of advances in medical techniques. A survey by the Royal College of Paediatrics of premature babies born at up to 25 weeks gestation found of those who were admitted to the neonatal unit but later died, 60 per cent did so because care was withdrawn.

Professor Neil McIntosh, chairman of the college's ethics advisory committee, said: "They would have been mainly 22 and 23 week babies who were not offered care because the doctors believed the chances of good survival were very poor. Babies of 25 weeks would be offered care."

In older children treated in intensive care units, 60 per cent of those who die also do so after their care is withdrawn. To help in deciding when care should be withheld, the college issued a document yesterday setting out five situations in which it might be appropriate to let the children die.

These include children certified as brain dead or in permanent vegetative state, who do not react or relate to the outside world. Three other situations identified include:

the "no chance" situation in which the child has such severe disease that continuing treatment merely delays death without easing suffering.

the "no purpose" situation in which survival is possible but the degree of physical or mental impairment is so great that "it is unreasonable to expect them to bear it.

the "unbearable situation" in which the child or their family feel that in the face of progressive and irreversible illness further treatment is more than can be borne.

The report cites the example of a baby born at 23 weeks weighing little more than 1lb who might be saved with weeks of intensive care but at high risk of severe mental and physical handicap.

A second example given is that of a 10-year-old girl with leukaemia who is not responding to treatment after a three-year struggle and whose parents decide that she has had enough. In a third, it is suggested that a teenager with muscular dystrophy who has no chance of surviving to adulthood and who develops pneumonia might be denied antibiotics and ventilation so he can die peacefully.

Professor McIntosh said the report had taken over two years to produce and had been re-written more than ten times because of the sensitivity of the issues. He said there was no escaping the fact that doctors had to make decisions about the quality of other people's lives.