Cultural Explanations And Clinical Ethics: Active Euthanasia In Neonatology

The authors have undertaken a study to explore the views in non-Western cultures about ending the lives of newborns with genetic defects. This study consists of including active euthanasia alongside withdrawal and withholding of treatment as potential methods used.

Apart from radicalising the support for active euthanasia in certain instances of neonatal diagnoses, is another interesting point that views of children and death are shaped by religion and culture and are especially highly charged with culturally specific symbolism/s. Furthermore, this is augmented in the context of non-Western cultures-further polarising the positivist ethics of Western scientific medicine from the cultures that affect only those who are members of 'other' societies.

From this starting point, the authors shift the focus from clinical explanations of the causation and prognosis of the genetic defects and enter a dialogue with cultural narratives. Consequently, their argument is, broadly, a reassessment of medical practice as a contextualisation of a particular culture/s rather than indifferent or independent from cultural forces or influences.

This is a radical claim. While it may be said that almost universally societies attach various meanings to the newborn child, because neonatology is a relatively new field, the context of such meanings in a clinical setting has been underexplored. As the authors point out, one of the methodological issues affecting the level of consideration to the presented survey questions is the lack of public attention on ending the lives of newborns. Following last year`s article 'After Birth Abortion-Why Should the Baby Live1' by Alberto Giubilini and Francesca Minerva, abstracting concepts such as personhood and moral status from the context in which they are embodied failed to recognise the cultural and personal values and preferences (certainly in a society like the UK). Rather, the heavy burden of neonatal care on public resources and the pressure to strive for uniform and fair standards of practices were prioritised.

Thus, these two very different articles represent the following binaries, namely, the 'clinical' and the 'cultural' as shall be termed in this article. Independently, they both call for a reassessment of medical practice as itself being a particular culture rather than indifferent or independent from cultural forces or influences. In this sense, such pairing of clinical and cultural explanations is interesting-the former appeals to a unified and neutral descri ption that amplifies a scientific reductionism of the human body and the latter engages with multiple ontologies. By virtue of their aetiology, cultural explanations are based on non-medicalised perspectives about the human body such as enactments of practices, rituals, and beliefs, as well as direct correspondence to an organised religion.

With our increasing diversity and the nature of contemporary medicine, cultural explanations are frequenting clinical ethics discussions. This is in response to neonatal intensive care increasingly producing cases of clinical ambivalence due to new possibilities in sustaining life from an earlier point in time. Also, the parent`s wishes are gaining a greater role in such decision making, requiring at times for ethical principles to respond to cultural understandings about the body.

Most significantly, the problem of premature neonates cuts through the very notion of respect for culture. The very culture of an Intensive Care Unit is part of the industrialised consumer affluent culture of the West. Immigrants from rural Pakistan, for example, do not bring with them cultural values and experience on such decisions, simply because they have no access to a Neonatal Intensive Care Unit. This is true for a large portion of non-Britons in the UK.

Modern neonatal intensive care is the site for life-sustaining treatment for extremely premature neonates or neonates that have either been diagnosed in utero or at birth with severe abnormalities or disorders. The survival of the high-risk neonate is a 'cultural phenomenon' produced by such scientific and technological innovation.2 Neonatal medicine is incurring new and unprecedented clinical challenges borne from evolving technological and scientific innovations. One of the most frequent practical dilemmas in modern neonatal intensive care is that of commencing intensive care but then withdrawing at a later stage-active withdrawal of life-sustaining treatment is a 'common mode of death' in some neonatal units, and the death, in the case, usually results from 'complications of extreme prematurity'.3

Lantos and Meadow`s4 refer to supporting (new) life in terms of 'quality of life' hereby translating the clinical context into a societal context. Decisions demanded by this 'new' medicine evade clear-cut clinical objectives-there is ambiguity, and the views of parents are frequently called upon. Parents, however, rely on values that are grounded in their cultural belief system.5

Ethical frameworks must continue to work to accommodate the changing nature of these clinical decisions; and the challenge for contemporary biomedical ethics in analysing cultural explanations in order to integrate parent`s wishes into both, the ethical and clinical treatment of their child, is currently needing development. While the article points out that multiple scenarios-representing different religious viewpoints, or different conceptions of the neonate-will offer more complex opinions, the pluralism is necessary to counteract the tension in providing a uniform neonatal body.