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Daily Mail story on care of sick babies was “highly misleading,” says BMJ editor

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8240 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8240
  1. Zosia Kmietowicz
  1. 1BMJ

The BMJ’s editor in chief, Fiona Godlee, has criticised the Daily Mail newspaper for misleading readers by publishing a highly inaccurate article on the care of severely disabled newborn babies that was based on a personal view article in the BMJ.

The Mail article appeared on its front page on 29 November with the banner “Now sick babies go on the death pathway: Doctor’s haunting testimony reveals how children are put on the end-of-life plan.”1

It claimed that the BMJ personal view, published anonymously on 1 November,2 was evidence that sick children in the NHS were being put on the Liverpool care pathway. It added, “The Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.”

However, in a letter to the Mail, which had not been published when the BMJ went to press, Godlee pointed out that “the doctor who wrote the BMJ article does not practise in the UK. Nor does the article mention the Liverpool care pathway” (box).

The Daily Telegraph ran a similar news item that was based on the Mail’s story and that has been shared many hundreds of times on social media. However, that story has been deleted from the newspaper’s website after a BMJ reader pointed out its inaccuracies, although the Telegraph has refused to post a retraction.

Journalists at the Mail did not ask the BMJ for permission to reproduce the personal view. Had they done so, they would have been told that the author of the BMJ article did not practise anywhere in Europe.

The BMJ had insisted that the personal view on the experiences on caring for babies with severe congenital anomalies be anonymous, to protect the identity of the family that made the decision to let their baby die.

The doctor who wrote the personal view told the BMJ that the Mail took the views expressed out of context and abridged them “to reflect the bias of the reporting.” The Mail article said, “One doctor alone admitted starving and dehydrating ten babies in the neonatal unit of one hospital alone.” In fact, the doctor said that such situations were “very rare”: 10 times in the doctor’s 13 years in a large specialist hospital.

The doctor added, “To juxtapose the article with pictures of healthy babies misrepresents the clinical situation entirely. Some babies are born without intestines or with other abnormalities that make oral feeding physically impossible. Others have such catastrophic medical conditions that continued artificial hydration would only prolong the dying process. One would never undertake a decision to forgo artificial feeding if it could in any way benefit the child. Parents request cessation of this treatment, and the health team deliberates about this extensively before any action is taken, not the other way round.”

In her letter to the Mail Godlee described the story as “highly misleading.” She added, “To suggest that parents are pressurised by doctors to allow their baby to die in order to free up hospital beds is false, unfair on dedicated medical staff, and exceptionally insensitive to parents who have lost a baby in these circumstances.”

A flavour of the misinformation created by the Mail was evident from comments on the newspaper’s website. Among them are some from US readers that berate state run healthcare systems, which the Mail has previously linked with advancing deaths to clear beds. Others express horror at the cruelty that doctors and nurses in the NHS inflict on those in their care.

John Ellershaw, professor of palliative medicine at the University of Liverpool and director of the Marie Curie Palliative Care Institute, with which he helped develop the Liverpool care pathway, told the BMJ, “The LCP has been consistently misrepresented in some sections of the media in recent weeks. Coverage has confused the best practice guidance it provides for healthcare professionals with actual practice on the ground.

“The vast majority of patients whose care is supported by the LCP experience much better care than was the case before the LCP existed, which is the very reason it was originally developed.”

Four days before the Mail story appeared four consultants from Great Ormond Street Hospital in London posted a response to the BMJ article saying that “withholding or withdrawing life sustaining treatment (LST), including clinically administered nutrition and hydration (CANH) with the intention of causing death, is unlawful.”

This response had received 15 “likes” from BMJ website readers at the BMJ went to press. But the comment with the most approval (19 likes) is from David Bihari, an intensive care physician from Artamon in New South Wales, Australia. He suggested “terminal sedation” to keep the baby as comfortable as possible. “A combination of morphine and a benzodiazepine in appropriate doses would ease the passing of this baby into the unknown. This is the least we could do for this unfortunate member of our species born with such a poor set of cards,” he concluded.

Some responses to the Mail story support this view and call for euthanasia to be legalised in the United Kingdom.

Godlee concluded her letter to the Mail by saying, “Sadly it is fact of life that some babies die. It is a highly distressing experience for everyone involved. There is an urgent need for a proper public debate on how health professionals should manage such cases. By hyping and misrepresenting this story, the Daily Mail has missed an important opportunity to advance that debate.”

Letter from BMJ’s editor in chief to the editor of the Daily Mail

Dear Mr Dacre

Your front page story (“Now sick babies go on death pathway,” 29 November) is highly misleading. It says that the events described in the BMJ article (“How it feels to withdraw feeding from newborn babies,” BMJ 2012;345:e7319), which you reproduced without our permission, are evidence of the use of the Liverpool care pathway on children in the NHS. Yet the doctor who wrote the article does not practise in the UK. Nor does the article mention the Liverpool care pathway.

The doctor was describing an extremely difficult situation—that of a baby born with severe congenital anomalies. As the article explained, these anomalies were inconsistent with a basic human experience and would have required extensive surgical and other treatment of uncertain benefit, which the parents did not want to inflict on their child. The decision to withdraw life support and allow the baby to die was made by the parents after a full discussion with the baby’s medical team.

The care of people at the end of life—whether babies, children, or adults—is a specialist area of medicine in which the UK leads the world. The practices of NHS staff are directed by national guidance that has been developed with expertise to deliver compassionate and dignified care at an extremely difficult time. To suggest that parents are pressurised by doctors to allow their baby to die in order to free up hospital beds is false, unfair on dedicated medical staff, and exceptionally insensitive to parents who have lost a baby in these circumstances.

Sadly it is fact of life that some babies die. It is a highly distressing experience for everyone involved. There is an urgent need for a proper public debate how health professionals should manage such cases. By hyping and misrepresenting this story, the Daily Mail has missed an important opportunity to advance that debate.

Yours sincerely

Dr Fiona Godlee

Notes

Cite this as: BMJ 2012;345:e8240

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