Letters

Wit hdrawing artificial feeding from children with brain damage

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7018.1502 (Published 02 December 1995) Cite this as: BMJ 1995;311:1502
  1. P E Shannon, Research registrar in anaesthetics
  1. Royal Hallamshire Hospital, Sheffield S10 2JR

    EDITOR,--Ronald E Cranford's editorial on withdrawing artificial feeding from children with brain damage aims to encourage debate about basic medical and ethical principles.1 Yet I believe that the central medical and ethical issues are not fairly addressed.

    Firstly, Cranford states that so called artificial feeding is medical treatment but implies that normal eating and drinking are not. Surely this is specious. Tube feeding, whether by nasogastric tube or gastrostomy, is largely done to protect the patient's airway from soiling and for nursing expediency. Moreover, “it serves the same purpose that eating and drinking do, [to provide] the food any human being needs.”2 Tube feeding is better considered to be part of tender, loving care rather than to have any therapeutic benefit itself. I am sure that doctors would never want tender, loving care to be removed from a patient. This point is supported by my experience that nursing staff are generally extremely reluctant to countenance withdrawal of feeding because they have an instinctive belief that it is part of nursing care and explicitly not a medical treatment.

    Secondly, Cranford concludes that allowing a child to die is not the same as euthanasia (or, presumably, infanticide). But in what way is it different? Both produce certain death. This sets the withdrawal of feeding apart from the withdrawal of other medical treatments, which merely increases the likelihood of death but does not guarantee it. The difference here is between, say, 99% and 100%—infinity. A spade should be called a spade. The proponents of withdrawal of feeding are, in truth, asking for permission to practise infanticide through privation. The next logical step is to give drugs to hasten the process.3 The Rubicon has been crossed.

    Children with severe brain damage present immense challenges toeveryone. If our only solution to the problem is deliberate killing what does that say about us? Can we see no intrinsic value in a person created in the image of God, or do we value only possession of abilities? Dyck at Harvard School of Public Health asks “whether we are the kind of persons who will care for [such children] without doubting their worth.”3 He believes in the equality of life rather than the quality of life ethic. Koop, a former surgeon general of the Public Health Service in the United States, agrees with him.3 So do I. So did Hippocrates.3

    Ethical principles exist to guide us with difficult issues despite the ever changing technology of medicine. We must recognise the difference between good medical practice and killing people.

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