Why do doctors need the consent of parents before euthanasing a child? This is the startling question posed in the advance on-line issue of the journal Bioethical Inquiry. Jacob M. Appel, a freelance bioethicist with a liking for radical theories, proposes that “While, in theory, allowing parents to render their own decision as to ‘how much suffering is too much suffering’ is speciously appealing... caregivers are ultimately less suited to make such determinations than medical experts.”

Of course, euthanasia is illegal everywhere in the US, so Appel’s idea is largely theoretical -- although Oregon and Washington have legalised physican-assisted suicide. But there are jurisdictions where it is already being applied in a modified form. For instance, the 1999 Texas Advance Directives Act permits doctors to remove “futile” treatment against relatives’ wishes. In 2005, in Hudson v Texas Children's Hospital, the courts upheld the right of the hospital to withdraw life support from a seriously ill infant against the mother’s wishes.

In the Netherlands, child euthanasia is already permitted under the Groningen Protocol (even though it is, strictly speaking, illegal) if children are suffering unbearably. However, even the protocol stipulates that parents must give their consent. Appel asks, why?

His observation is that US law is steadily moving towards a model which requires not parental consent, but parental permission. This elevates the child’s welfare (as determined by doctors) over the opinion of parents. In some situations, such as blood transfusions for Jehovah Witness children, this seems understandable. But Appel asks, if it is allowable in life-sustaining situations, why not in life-terminating ones?

In another thought-provoking twist, Appel points out that non-traditional families are hard-wired for conflict and that doctors need to take charge.

To allow adversarial parents to litigate over whether to euthanize a terminally-ill infant — while that infant suffers in the interim—seems a highly-inflammatory approach to settling an already distressing situation. If we are to allow neonatal euthanasia at all, shifting the ultimate choice from relatives to medical experts should occur before an intra-familial battle royal arises, such as the case of Terri Schiavo.

~ Bioethical Inquiry, May 5