Wednesday, August 5, 2009

American Academy of Pediatrics recommends when children can be killed

The American Academy of Pediatrics (AAP), a respected and influential medical organization of some 60,000 members (ostensibly "Dedicated to the Health of all Children"), has recently published something which any morally sane American should consider highly disturbing, to say the least.

In the August, 2009 (Vol. 124, No. 2, pp. 813-822), issue of their monthly scientific journal, Pediatrics, the AAP published an article--a "clinical report"--titled, "Forgoing Medically Provided Nutrition and Hydration in Children." [available online here; pdf here] The two authors of this article (both medical doctors) are the present and immediate past chairpersons (their term; I prefer 'chairmen') of the AAP's Committee on Bioethics. And so this article represents the current point of view of the bioethics experts of the American Academy of Pediatrics on the subject of withholding food and water (i.e. nutrition and hydration) from living children. From what I can gather from their web site (their "Clinical Reports" index, here, which includes this article, is listed under the heading of "AAP Policy"), this represents official policy of the AAP. At the very least, this will be influential among pediatric medical professionals. To some degree it may represent already established opinion among them.

In the conclusions section of the article is the following: "The primary focus in decision-making should be the interests of the child." What does the AAP consider in the interests of the child? When do they say a physician may withhold food and water?

Medically provided fluids and nutrition may be withdrawn from a child who permanently lacks awareness and the ability to interact with the environment. Examples of such children include children in a persistent vegetative state or children with anencephaly. [conclusions, no. 6]
I stress loudly that such children are not necessarily dying! A persistent vegetative state, especially, is not a lethal condition--imminent death is not in the prognosis for PVS by itself. The AAP thinks it is morally permissible to kill children who are not dying, but severely injured, by withholding nutrition and hydration. They do not call this killing. But in a sound moral analysis, it certainly is.

Further, the article states, "Because individuals in a persistent vegetative state are unaware of themselves and their environment, the provision of medically provided fluids and nutrition does not confer them benefit and may be withdrawn." This position is essentially utilitarian. It does not assume that human life and human existence is, in itself, essentially good and valuable. It reduces the value of human life to something dependent upon the awareness of the individual. This is an extremely dangerous and morally bankrupt position to take. The AAP now holds that if life isn't worth living according to its understanding of a worthy, beneficial life, then it is a legitimate option to end the patient's life by not giving them nutrition and hydration. Such is the state of bioethics among the leadership of mainstream medical organizations.

It is helpful to have the following background information: the AAP considers providing nutrition and hydration (food and water), by feeding tube (a tube going into the stomach or small intestine) or intravenously, to be "life sustaining medical treatment" (LSMT). Here is a quote from AAP official policy:

Life-sustaining medical treatment encompasses all interventions that may prolong the life of patients. Although LSMT includes the dramatic measures of contemporary practice such as organ transplantation, respirators, kidney (dialysis) machines, and vasoactive drugs, it also includes less technically demanding measures such as antibiotics, insulin, chemotherapy, and nutrition and hydration provided intravenously or by tube.
[Guidelines on Forgoing Life-Sustaining Medical Treatment]
Thus, leaders among our pediatric specialists officially consider antibiotics, insulin, and food and water (given by tube into the stomach or by a smaller tube into a vein) to be "Life Sustaining Medical Treatment." In other words, these are considered interventions that may, under some circumstances (some not life threatening), be forgone. A very serious question must be asked: Do they approve forgoing such treatments for the sake of bringing about death--where it would be understood (even if not stated explicitly) that death would be a direct result (as contrasted with allowing an already inevitable death to take place by forgoing treatment)? The answer, clearly, is yes (see above).

Why is this a huge concern? Because the medical community does not seem to recognize the moral difference between allowing certainly impending death to happen, death which will come as a direct result of an incurable lethal disease or injury, vs. deliberately killing the patient by keeping food and water from him or by omitting other routine and probably effective antibiotic or insulin treatments for secondary and not-necessarily lethal conditions. We are in serious trouble when our doctors do not recognize the difference between choosing to stop fighting against imminent death and choosing to kill.

The official AAP web site states [see AAP Fact Sheet] that their mission is "to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults." How do they pursue this mission? "One of the AAP’s major activities is to further the professional education of its members. Continuing education courses, annual scientific meetings, seminars, publications and statements from committees, councils, and sections form the basis of a continuing postgraduate educational program." [Fact Sheet]. In other words, they educate and influence pediatric medical professionals, in part, according to the considered positions formed by their various national appointed committees. One of these is the Committee on Bioethics whose chairperson and immediate past chairperson wrote this article.

Should this matter to Catholics (and to any Christian)? Absolutely! Euthanasia, however well-intentioned (i.e. killing so as to end suffering), is never permissible. Killing the innocent is killing the innocent--and never OK. There is a commandment (you know, the Ten Commandments) against it. Here is the definition of euthanasia used by the Catholic Church: "an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated." [Declaration on Euthanasia]. Choosing not to give nutrition and hydration in the case of a non-lethal situation where food and water can still be assimilated by the body is an omission; it is a choice made for a specific purpose--to cause death. Likewise for antibiotics and insulin.

Christians do not do this. It is never permissible under any circumstances. Our calling is never to take another person's life, but rather to provide a self-giving, person-oriented service of love and compassion. We are to do all we can to comfort others, lessen their suffering, and to accompany them in their suffering--to suffer with others in solidarity as best we can. We are to show those who suffer by our caring presence that we love them, and that they are worth being with no matter what is happening to them. To do this well, we need grace. May we pray for it, and may God grant it to us.


  1. I would say that the hyperbole in which you engage your opening comments, suggests that you have you have not understood the report, or that you are wantonly trying to distort its intent.

  2. I am very aware that some in the medical profession (including, as I pointed out here, the leadership of the AAP) do not consider it killing to end someone's life by deliberately withholding food and water from them so as to cause their death. They encourage the general culture to agree with this by including the provision of nutrition and hydration by feeding tube in their definition of "life sustaining medical treatment," thereby lumping together things as massively different as artificial ventilators, heart-lung machines, and food and water given by a tube.

    In a sane and healthy society, we don't get to redefine what constitutes killing another innocent human being. My basic point is that no matter what some medical elites hold, it is indeed killing someone to deliberately choose not to give them food and water (i.e. nutrition and hydration), including if by a tube, if one knows that by doing so it (the lack of food and water) will be the cause of their death.

    So, from my point of view (and this is the analysis of the Catholic Church), causing a person's death specifically by willfully depriving them of the basic necessity that every human being needs to live--food and water--is killing. Just because a person has a serious debilitation (e.g. a mental deficit caused by a brain injury; Parkinson's; Alzheimer's) does not mean they are near death. If a person's body can still assimilate and use nutrition and hydration, we are obligated, according to basic human decency and the ancient and fundamental moral code "thou shall not kill," to provide these for them.

    I doubt whether this would have been cause for any substantial disagreement only 50 years ago. There was a time, not long ago I believe, when even medical professionals (especially!) knew that it whether one shoots someone in the head with a gun, or dehydrates them to death, it is the very same thing from a moral point of view. Just because one is slower and less messy does not make it one iota more acceptable morally.

    Killing is killing. It doesn't matter what the method used is. If I know for a fact that a certain course of action will end your life, and then I go ahead and do that which in fact ends your life, I have killed you.

    Following this horrible trend, it won't be long before medical professionals try to justify giving people lethal injections as a legitimate part of ordinary end-of-life care. It's the same thing they are already doing by withholding food and water--except quicker and it frees up a hospital bed sooner for the next victim.


Thank you for civil and well-considered comments!