“A newborn is not a person, because a person is someone who has
self-consciousness and has a sense of morality and rationality. In some
cases of severely deformed babies, it could be reasonable to accept
euthanasia like in Holland.” This simple idea, not really impressive
and not revolutionary at all (read Engelhardt and Singer, for a start)
generated a massive uproar and was accused of being profoundly
offensive and provocative.
This sentence was pronounced by paediatrician Gianfranco Vazzoler at a
convention on “The challenges that neonatology poses to bioethics and
to society” promoted by the “Consulta di Bioetica” in Florence (30 -31
of October). Doctor Vazzoler’s sentence was misquoted, isolated from
its proper context and used as a pretext for slinging mud at the
convention. Italian newspapers that reported the convention only said
that “these doctors” want to kill handicapped newborns. Nothing else.
The manager of the hospital where the convention took place soon
declared in an interview that he wanted to “ pre-emptively distance
himself from these offensive and unacceptable words” (La Repubblica,
1st of November), and in the same newspaper article, a priest explained
how “everyone that belongs to the human family deserves respect,
otherwise we introduce a discrimination undermining the civil
coexistence that is based on the dignity of every human being,
regardless of his own qualities.”
In an article published on the 3rd of November, the newspaper called
“Il Foglio” underlines how this proposal of practising euthanasia on
handicapped babies “is exactly what was systematically done during the
third Reich.” According to that article, “About thirty years after the
Italian law on abortion, a law that was introduced to safeguard women’s
health and self-determination […], the most systematic and ferocious
violence is practised on the bodies and on the souls of women and of
conceived babies, all this in a context of collective moral
indifference disguised as respect for the human rights of women”.
The most important Italian bioethics experts (philosophers, lawyers and
doctors) attended this event, as well as a special guest, Dr Eduard
Verhagen, from the department of paediatrics at the University Medical
Center of Groningen and widely known as one the authors of the
Groningen Protocol.
The aim of the meeting was a serious discussion about moral dilemmas
brought about by the recent advances in neonatology. New technologies
have made it possible for extremely preterm infants (EPI) to survive,
but if neonatologists face severe cases of EPI they may be unsure
whether to resuscitate them or whether to just help them to die in the
least painful way. The document known as “Carta di Firenze” (The
Florence Document), published in 2006 and giving rise to conflicting
reactions, suggested guidelines for EPIs“of uncertain viability”
between 22 and 25 weeks of gestation, between 400-600 grams heavy and
between 20-30 cm tall.
The Document basically proposes that decisions about what kind of
treatment doctors should practise on EPIs (and also if starting a
treatment is recommendable in the most hopeless cases), should be based
on the medical condition of the individual child and not just on the
base of its age of gestation. The Document also recommends involving
parents in the choice. This means that doctors should give them
essential information like, for example, the fact that there is a high
risk of severe iatrogenic damage associated with the resuscitation of
severe EPI cases.
A workgroup of the Consulta di Bioetica wrote a new document (presented
during the Convention) that supports, after a thorough analysis from
both a philosophical and a medical perspective, the validity of the
“Carta di Firenze” guidelines.
But the newspapers reporting this conference didn’t mention anything of
these discussions and guidelines to the Italian citizens. Nothing
really important was communicated. All the Italian newspapers shouted
“Scandal!”, and in this mess, public debate on how should we treat EPI
was forgotten.
Professor Maurizio Mori, President of the Consulta di Bioetica,
commented on these events in a press release remarking, amongst other
things, that Italian newspapers are “clearly trying to not give certain
ideas the chance of being discussed, unlike in the rest of the
civilized and culturally advanced world.”
It’ s really a pity that such a good chance for dissemination of
relevant information has been wasted this way: “so much ado about
nothing” and so much silence about something important.
Some references, many other articles are available on internet
For reading Italian press review on bioethics please check this link:
www.iss.it/sibi/stam/index.php?lang=1&tipo=6&anno=2008
Carta di Firenze 2006, link: senseable.mit.edu/florence/Carta%20di%20Firenze.pdf
The Groningen Protocol, http://content.nejm.org/cgi/content/short/352/10/959
“La Carta di firenze oggi”, Documento presentato nell’ambito del
Convegno “Le sfide della neonatologia alla bioetica”, Firenze 30 e 31
ottobre 2008, http://www.consultadibioetica.org/
La Nazione di Firenze, 31 of October page 1
La Repubblica, 1 of November 2008, page 18
Il Riformista, 2 of November 2008 page 4
Il Foglio, 3 of November 2008, page 1
Release Remarking on the Reactions to the convention, 6th of November http://www.consultadibioetica.org/index.php?p=comunicati_2008
“The Document basically proposes that decisions about what kind of treatment doctors should practise on EPIs (and also if starting a treatment is recommendable in the most hopeless cases), should be based on the medical condition of the individual child and not just on the base of its age of gestation. The Document also recommends involving parents in the choice. This means that doctors should give them essential information like, for example, the fact that there is a high risk of severe iatrogenic damage associated with the resuscitation of severe EPI cases.”
What would the physicians think about, and what would the physicians and parents talk about, when determining what to do with EPIs. Surely, the medical condition of the EPI and the risks to that child over the term of its expected life can’t be the whole of it. There must be more. such as the (moral) value of life and the importance of preserving it, and the ethics of dealing with neonates with some chance of survival for longer than a day.
The physician’s task, I think, is to provide medical information to the parent. Perhaps the physician can go further and engage in ethical/moral counseling with reference to the cultural mores of the time and place. But that’s it. How do the parents deal with the problem of letting the child die or helping it live? Do they ask “who pays for all this?” and take their economic circumstances (and other obligations, perhaps to other of their chileren) into account? There has got to be more than just this conversation between physician and parent. There has to be someone who can help this address this problem which involves no plain or even dimly apparent right path to the right result, and someone who can help the parents (and the physician) live with their decision.
‘“A newborn is not a person, because a person is someone who has self-consciousness and has a sense of morality and rationality. In some cases of severely deformed babies, it could be reasonable to accept euthanasia like in Holland.” This simple idea, not really impressive and not revolutionary at all (read Engelhardt and Singer, for a start) generated a massive uproar and was accused of being profoundly offensive and provocative’
The parents of newborns tend to lavish as much care on them as if they were persons, despite their lack of self-consciousness, sense of morality and rationality. Perhaps these parents have failed to grasp the simple idea that a newborn is not a person. Or maybe they have a different and equally simple idea: that newborns are, after all, persons.
There are good justifications for not treating severely ill babies, e.g. that the life saved will cause more pain and misery to the person living it than the forgoing of that life. But there are also specious justifications that will provoke, offend and cause outrage. Amongst these is the principle that newborns are not persons. That is because it carries the implication that newborns generally are of little value to us because of their lack of adult capacities. But the contrary is clearly the case.
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