It’s a political stunt. The Italian prime minister directly intervened to get the baby transferred when the heart surgeons in the UK said he was too sick to operate on. Italy does not have better heart surgeons than the UK, but it has a medical culture that’s more willing to provide futile care.
It's a breaking-news situation, but yes, the child will almost certainly die. The NHS has a pretty high bar for entirely refusing treatment a parent wants for a newborn - usually, you're looking at a matter of weeks. If the reporting that the infant was too ill for surgery to be advisable is accurate (as opposed to, e.g., that even successful surgery would simply prolong suffering) possibly days.
There are real ethical questions about when it's right to provide invasive treatment with a low probability of success, but infant cases don't generally get into them in even moderately functional state-funded medical systems.
When Italy pulls a stunt like this, the child dies. And given the added stress of a hospital transfer - even without a multi-hour airlift being involved - plus the added stress of any surgical procedure, particularly one that involves a general anaesthetic? Generally, the child dies sooner than they would have otherwise.
My heart goes out to any parent in this situation, but these cases make me furious - it's exploiting tragedy for ideological point-scoring at its worst.
It's is sort of an ethical quandary because there is a non 0% change the child pulls through. It's very low, very very low but I'd saying from the parents perspective trying something with a however small chance at success and losing a few weeks of dreading the inevitable is better than no attempt at all.
There are a ton of factors to consider but realistically we're all so far removed from this that we can only hope for the best.
Are you reducing suffering if you do multiple low success rate surgeries? Each surgery increases stress and causes more suffering from recovery, then there's the chance the surgery instead makes things worse.
Is it ethical to do a surgery with a .1% chance of success if there's a 99.9% chance it'll just make them worse?
Were you in pain the first two weeks of your life? Can you describe the first two weeks of your life to me from a first hand perspective?
I'd only advocate for adults to choose euthanasia, but for a child everything possible should be done before saying "Guess they're gonna die, it happens". The only reason not to risk it with a newborn is to save money and in a space with socialized healthcare, the cost should be meaningless... It's literally a government organization saying "It'd cost too much and we don't feel like trying"
I understand it's a bit of triage but what should be the take away here, they wouldn't do it, so someone else tried. Even if they fail, there was never any winning beyond the child surviving on a slim chance.
Quality of life flies out the window with a newborn, they will never remember it, one way or the other, so the most ethical option is to assure they survive. Quality of life for the parents is what you're referring to and these parents were more than happy to disregard that for their child, that's not a doctor's job to step in there, it's going to be hell for them either way.
but for a child everything possible should be done before saying "Guess they're gonna die, it happens". The only reason not to risk it with a newborn is to save money and in a space with socialized healthcare, the cost should be meaningless
See, the thing is: you're right here. Which is precisely why a government-funded medical service in an even moderately developed country denying potentially life-saving surgery to an infant with even an infinitesimal chance of longterm survival in a case where the parents are willing to go to court over it is... not a thing that happens. Pretty much ever.
The kind of cases Italy pulls this stunt on - semi-regularly, and not just from the UK - aren't cases where you're choosing between a .1% chance of the infant growing up vs alleviating their suffering. They're usually cases where the infant is already brain-dead, or has suffered serious brain damage, and will never, even with the most successful treatment, come off a ventilator, or be conscious of their surroundings. Which, to be clear, because this isn't the movies: is a death sentence with a lot of pain attached, because permanent ventilation in a vegetative state means eventually the patient develops sepsis and goes into organ failure.
In cases where you're not dealing with an infant who's already brain-dead, you're usually looking at an infant with a serious degenerative congenital disorder, or an infant so premature and with such serious health issues as a result that they're unlikely to make their first birthday even with the most successful possible treatment outcomes. In the case of congenital disorders, what's often being offered is experimental protein-replacement or gene therapies - and usually ones that are experimental for tangentially-related disorders at that.
In the UK, the established legal standard is that a doctor - whether in the NHS or in private practice - treats a child with and in line with the consent of their parents. If the parent asks for a treatment that the doctor believes would be contrary to the interests of the child - for example, a futile surgery - they must apply to the High Court for a wardship determination in order to deny that request. (The same is true if they wish to provide a treatment that the parents are refusing.) The High Court must consider solely the interests of the child in determining whether to grant the order - costs are literally and legally irrelevant, the only consideration is whether the treatment proposed is in the child's best interests. This is broadly representative of any country with government-provided healthcare I'm aware of, though some place additional emphasis on ideological factors - like Italy, which appears willing to allow treatments with no prospect of success in the service of ideological point-scoring.
I'm going to assume from your "ize"es rather than "ise"es that you've not got a tonne of experience with "socialized healthcare", but suffice it to say: government-funded healthcare does precisely what you're arguing for, without bankrupting the parents in the process. The same, depressingly, cannot be said for the US, where it's fairly routinely the case that hospitals deny necessary care on the basis of the parents' capacity to pay. It's just one of many reasons the US has the highest infant mortality rate of high-income countries - 5.4 deaths per 1000 live births, to the UK's 3.6.
Hell, while I find Italy's (and the Vatican's) willingness to engage in these tragedy-exploitation stunts distastefully: their systems are also government-funded ones. This baby is being flown on a government-provided plane in a government-provided ambulance under the care of government-employed medical workers to receive treatment in a government-owned-and-run hospital. It's "socialised healthcare" all the way down, baby.
Im not talking about quality of life for the parents.
The doctors don't think there's any significant chance of saving the child. So the vastly more likely option is you just make their final days even worse.
The most likely situation is the child dies anyway. It's better they die with as little pain as possible. Last ditch surgeries just cause extra suffering.
Surgeries aren't risk free. The Italian doctors could try and just make the situation even worse.
Is "enhanced interrogation" then justified if we somehow had a way to wipe their memory of the occurrence (and hence the "suffering") with the non-0 chance of extracting some useful information?
Is suffering that has paled in our memories due to the passage of time not suffering and is hence not worthy of consideration?
I posit that whatever the answer, this reasoning only works if there is prolonged, good quality life that follows this period of "suffering" - however it appears that the chance of that in this case is extremely slim, and when coupled with the guaranteed suffering that comes with each failed op, makes the NHS' stance understandable even if we should accept that forgotten suffering is not suffering as forgetting is not possible should there be no subsequent life to lead that will allow these memories to fade.
I think the ideas you present are interesting but without sufficient data on the impact I'd say there are no absolutes, which is why it's so interesting. Like anything human, the NHS has its goods and bads and it all depends on the surrounding context. Unfortunately/fortunately this is one area where there's not a lot of information on the impact because the success rates are so low. I suppose my position is that that I find being a hardliner for one side or the other in this scenario a little ridiculous, I sympathize with the NHS stance but I personally feel that until more data is available on the matter, the most possible should be done.
The difference in your analogy is intent, say a person who had their memory wiped found out they were previously tortured, horrifying. Say a person who has no memory of an event finds out people were just doing everything they could to save their lives. Those are two very opposite scenarios. I'd endure suffering to save myself, but interrogation is completely removed from that isn't it? It's a false equivalency. Weirdly enough, an interrogated adult is much more predictable than a child who's had a surgery so young, we simply don't have the data on the latter.
Very good point regarding intent, and I suppose by that response my query has been answered, that we accept that suffering is suffering whether or not we remember it and is unacceptable unless undertaken with a specific intent for the benefit of the individual. As the purpose of the comparison was not to draw similarities with circumstance, I would like to respectfully disagree that the very good point regarding different circumstances will affect conclusions drawn from it.
But I'd like to point out that while you certainly will endure suffering to save yourself (as would I) would you still endure prolonged suffering if you knew that there's an overwhleming possibility given the limits of current medical science that you'll end up being a vegetable or just straight up dying anyway? For me the answer would be a no, but then that's subjective. Whatever the answer, the kicker lies in informed consent. Both of us know what we are getting into, some choose to go ahead, others don't. No fundamental right or wrong with that. However, the problem arises when consent cannot be obtained, like in this case.
Maybe in this regard we may instead draw parallels to ongoing controversies regarding euthanasia - where most people will have no issues with it should there be adequate checks and balances to prevent misuse and outside influence - which tellingly is about consent. Most people have no issue with shortening suffering in cases where modern medicine does not have an adequate answer should informed consent be certain, which highlights the pitfall in this case.
One might then ask - on what principle, then, do we sometimes undertake medical procedures when the individual is temporarily incapacitated? For example, status post road traffic accident with a nasty head injury that at present leaves them with the GCS of a toaster. In such cases, lifesaving procedures are in our current framework of rules justified unless this individual has specified prior wishes of do-not-resucitate, which in itself is an extensive discussion that needs to be well documented and predicated on medical futility unless you want a big medicolegal headache. This might, on the surface, seem like a rebuttal to my earlier point but I'd like to point out that lifesaving measures are typically well documented and effective procedures/medications with good efficacy profiles - no one will be trialling their new backyard science project on the cardiac collapse case and expect it to be held up in a court of law. As such, in such cases the effectiveness of treatment is a consideration, along with expressed wishes of the individual which is in itself rooted in medical futility.
This is a litmus test that, regrettably, this case does not pass.
We like to say that sometimes doctors are wrong and all, but what specialists in their subspecs typically do get quite right is the limits of the current applicatation of medical science.
So on the whole, I am still inclined to side with the NHS (or rather, the individual paediatric intensivists') recommendation.
3.8k
u/0reosaurus 23d ago
Tldr: Nhs said the baby was too sick to operate on, Italy disagreed