Critics condemn '23-week' premature baby ban

The medical world was divided yesterday over a report calling for extremely premature babies born before 23 weeks gestation to be denied intensive care and allowed to die.

Critics condemned the report, for imposing a "blanket ban" on treatment and demanded that each case be assessed on its merits.

The Nuffield Council on Bioethics, which published the report, said the only exceptions to the rule should be where parents strongly objected, even after being told of the very high risk of death or disability in these babies, and doctors agreed to provide treatment.

Even where this requirement was fulfilled, babies born before 22 weeks should only be given intensive care as part of a research study, it said. The Disability Rights Commission said: "We are against such a blanket rule. The decision to treat or not to treat should be based on individual assessment. To fail to do so would potentially be discriminatory and breach human rights legislation."

John Wyatt, professor of neonatal medicine at University College. London, said judging the maturity of babies was "unreliable" and assessments of gestational age could vary by "up to two weeks". "Although I welcome the guidelines, doctors must continue to indvidualise care in each unique situation. Cut-off times don't necessarily fit neatly with clinical practice."

The British Medical Association agreed saying "blanket rules do not help individual parents or their premature babies". The 250-page report was commissioned two years' ago in response to advances in neonatal medicine that have meant more can be done, but have provoked clashes between parents and doctors which have increasingly ended in court.

Most extremely premature babies still die (99 per cent of those born before 23 weeks) or survive with disabilities (two-thirds of those born between 23 and 24 weeks).

Defending the need for guidelines, Prof Margaret Brazier, chair of the working party that produced the report, said doctors were frequently limited in what they were able to tell parents and both they and parents needed help.

"Natural instincts are to save all babies even if the baby's chances of survival are low. However, we don't think it is always right to put a baby through the stress and pain of invasive treatment if the baby is unlikely to get any better and death is inevitable," she said.

The report rules out euthanasia saying doctors have a professional obligation to preserve life. To end life deliberately would alter the ethos of medicine, threaten the relationship between doctor and patient and suggest the infant had a different moral status from older children and adults, for whom euthanasia is banned.

But treatment could be withheld or withdrawn, where to provide it would involve the baby in "intolerable" suffering.

A statement from the Church of England House of Bishops, and the Catholic bishops conference of England and Wales, said: "This reaffirms the validity of existing law prohibiting euthanasia, and upholds the vital and fundamental moral principle that the deliberate taking of innocent human life is always gravely wrong.

"There is a clear distinction between interventions that are deliberately aimed at killing and decisions to withhold or withdraw medical treatment when it is judged to be futile or unduly burdensome."