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PaperclipPerfector  5mo ago (text post)   27123 thread views

Culture War Roundup for the week of November 6, 2023

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They is currently an 8 month old baby in the UK with a mitochondrial disease which is almost definitely terminal. The babies name is Indi: https://abcnews.go.com/International/wireStory/italy-grants-citizenship-terminally-ill-british-baby-after-104666139

A UK judge has ordered that that the baby be killed. Her parents have protested this, saying that they don’t think the government should kill their baby.

The Catholics have said: give us the baby and we will put the baby in our pediatric Vatican hospital, and the Italian government has said they would cover the medical bills. The Italian government has also said that the family can have Italian citizenship.

The UK has said no, you can’t leave, you need to keep the baby here so we can kill it.

I know this sounds hyperbolic, but…I don’t think it is. Read the article. Absolutely deranged behavior.

I understand that in socialized medicine countries there is some calculation about how much life support will cost, and famously in Canada sometimes this means the government just tries to get you to kill yourself, but that doesn’t seem to be the case here. The Catholics are being pretty Catholic about this and just trying to save the baby. The UK government won’t let them and insists that they should just kill her.

Insanity.

Under British law, the primary issue in such cases is whether a proposed treatment is in the best interests of the child. Judges have repeatedly upheld doctors’ decisions to end life support even when that conflicts with the parents’ wishes.

So, for some reason, it is up to the doctors and judges whether the baby should receive life support, and not the parents, and furthermore, somehow that means they can prevent a child from leaving the country if they're going to get medical treatment they consider to not be in the best interests of the child, which in this case is undergoing painful treatment instead of letting her die? Do I have that right?

Why isn't it up to the parents why can't they take their child out of the country? What's the legal basis for this?

It makes a little more sense in custody disputes where the parents can't decide something so then a judge intervenes and picks a side, but in this case, both parents want the child treated. So why don't they get to make the decision?

Usually parents have autonomy over their children's treatment. If doctors believe that the parents are acting massively against their child's best interest, then they'll take it to the courts. This is because under law the doctors have a duty of care for the child, otherwise the doctors would be deemed negligent. So here it is a case of doctors vs parents.

In these case, the court will act in the child's best interest. So here, you might think paradoxically, the best interest is to withdraw care and allow the child to die. Modern medical technology can prolong death and make it a long and painful process. See Scott's blog for more on this.

If two parents wanted to let their baby die instead of receive care, would you defer to their judgement in the same way?

If it's terminally ill I would say yes. If it has some easily treatable condition I would say no.

Because it can amount to torture, and we don't generally allow parents to do that. Parental rights are not unlimited.

I lost a child myself, so I understand the pain and grief the parents are going through. But if the child is in significant pain and is not able to be treated ( which doctors seem to agree on), then its a choice of a long drawn out painful death or a quicker painful death. The parents in this state may not be able to make objective choices about what is best for their child.

or a quicker painful death

Why isn't pumping the patient full of heroin never an option? Hell, keep the little bugger on a cocktails of joy drugs or whatever until it dies of RNA related malnutrition ( You can guess I'm not a doctor ).

I have a doctor story about that. My aunt was in pain and dying of a quick cancer, and I asked a doctor why they couldn’t give her morphine, and he told me that they couldn’t because it would increase her tolerance. I give doctors some slack for their high intelligence to open-mindedness ratio because they have to deal with so many lying idiots, but I still find them insufferable. It’s like they’re not talking to you, they’re just reciting you your miranda rights.

Is the bureaucracy with all its political biases the best place to make that call?

In the average case, parents with consultation from doctors are the best persons to make that call, and that's why they do make that call (I'm guessing) ~99.999% of the time.

But sometimes that process doesn't work for whatever reason, and the government steps in.

This isn't weird, it's approximately how things are supposed to work with the legal system. 99.999999% of the time, men choose not to rape or murder or rob anyone; when one of them is an outlier who makes the wrong choice, the government has to step in to correct it.

I don't think it's inconsistent to say both 'Citizens make their own choices' and 'The government fordbids a small corner of decision-space with extremely bad outcomes for other people'. Lots of things constrain a person's choices, including brute physical reality, capitalism, social policing, etc; we're right to worry and fight over how much an individual's choices are restrained and guided, but I don't think it's right to say they're not making them.

You mean doctors? Then a judge? Yes probably.

Good thing that it's not just some nameless bureaucracy making the choice here but all the involved doctors also agree with it.

As someone with lots of personal & professional experience with doctors (working as a postdoc in medical science and helped the father of a close friend navigate his own cancer diagnosis), I have to take the opposite position. Doctors have a very strong tendency to groupthink, to defer to the leading doctor and to generally behave in such a way as to maximize ass-covering as opposed to the best interest of the patient. They can and will manipulate and keep secrets from you for the purpose of their own convenience. Don't misunderstand me, they do so since they're extremely overworked and just try their best to do good with limited time and resources, but they will frequently miss the mark especially in unusual cases.

Why is the pain necessary? Just put the baby on powerful enough painkillers to risk brain damage if necessary, then go for the long drawn out chance of life.

At 8 months, that will just kill them, which doctors are not allowed to do. They have to follow things like the Liverpool pathway which is withdrawal of support or feeding etc.

No, it will not kill them. We routinely sedate 8 month old children for various medical procedures. It can even be done for a long time as long as the risk of long term complications is acceptable.

Infants can't be sedated or given strong painkillers?

Yes, they can most definitely be sedated or be given very strong painkillers. They can cause permanent harm if done for extended periods of time, but it can be done. Speaking from a related expertise- I'm an anaesthetist.

Not if it will be harmful to them, in the UK at least. A compromise between a doctors moral and legal duty to do no harm and the cruel reality that some people can't be treated and death might be a kindness. They are allowed to withdraw life saving care but not give treatment that itself causes harm. The idea being that not saving someone is not the same as killing them.

Its been an ethical debate for a long time, Google Liverpool Care pathway for more (though it isn't called that any more i believe).

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