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Costeloe dismisses some of the key issues and draws attention away from the dangers and limitations of the current approach.1 I question our current interpretation of “active” and “passive” euthanasia. How exactly is extubating a child with serious pulmonary disease (which may or may not improve) different from giving him or her a lethal injection? The former action is legal, accepted practice, the latter is not—does this make sense?
Cases such as the above example are usually covered by a concurrent opiate infusion. This is administered under the so called doctrine of double effect. When a baby or child is taking terminal gasps or making similar movements the care team will often increase the infusion to reduce distress. Do they genuinely know the child is in distress or are they responding to the family's and perhaps their own distress? If the latter the action may well be entirely appropriate—but it is not reasonable to argue it is covered by the doctrine of double effect under which it is taken.
Furthermore, what is the effect on the morale of staff who might be involved with a practice of legalised active euthanasia? Does anyone know it would be detrimental? I know from my own practice that the effects on staff who deliver ongoing futile care can be destructive—so which is worse?
Decisions expected to result in the death of a patient, through act or omission, active or passive, should be confidentially registered and available for scrutiny through both research and audit. Only then will we be able to understand current practice, ensure it is safe, and move on to properly consider even more challenging issues.
Competing interests: None declared.