Babies born after only 22 weeks in the womb should not be routinely resuscitated, according to a report on guidelines for doctors and parents on treating premature babies, which was released today.
The Nuffield Council on Bioethics, an independent ethics body, has found that premature babies born at 22 weeks - whose chances of survival are low and disability high, should not be put through the stress and pain of intensive care treatment.
The controversial report called Critical Care Decisions in Fetal and Neonatal Medicine, sparked debate before its release, in particular from religious groups on whether premature or sick babies should be allowed to die.
Beginning its inquiry two years ago, the council says that advances in medicine mean that families and doctors can be faced with "extremely difficult decisions about the care of very premature or seriously ill babies".
"These decisions are complex, emotionally demanding and may have lifelong consequences," it said.
The council, an independent body, was established in 1991 to examine ethical questions raised by advances in biological and medical research.
While it has no enforcement powers, it has sent its report to the Department of Health and the Royal Colleges.
Figures suggest that no baby survives at 21 weeks while 1 per cent may survive at 22 weeks. Only about 1 per cent of babies born between 22 and 23 weeks survive to leave hospital.
The council recommends that normal practice should not be not to give intensive care at this age, unless parents request it after a thorough discussion of the risks and if the doctors agree.
"Natural instincts are to try and save all babies, even if the baby’s chances of survival are low," said Professor Margaret Brazier, who was leading the working party.
"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."
Medical experts have argued that using invasive treatment on very sick babies - such as putting tubes down the throat or inflicting up to 15 procedures a day - actually "prolongs the process of dying".
Doctors then face the question - which is not always clear cut, over which babies will survive and which will need constant care and assistance.
John Wyatt, professor of neonatal paediatrics at UCL, said that he welcomed the report, particularly the strong statement against the intentional ending of life in critically ill babies.
However he was concerned the findings put great emphasis on managing babies by their gestational age, when in practice, assessing the maturity of babies can be unreliable and can vary by up to two weeks.
"Although I welcome the guidelines, I believe that doctors must continue to individualise care in each unique situation - in other words cut off times don't necessarily fit neatly with clinical practise," he said.
The Church of England, in its submission, said that every life is valuable to God, but there could be rare circumstances when treatment was futile and a child could be allowed to die.
The report also offers guidance on how to resolve arguments between parents and doctors over the fate of their child.
The number of extremely premature babies being born has been increasing since the 1980s. The age at which premature babies can survive has been falling by around one week every decade over the past 40 years. But most will still die.
The UK has the highest rate of low-birth-weight babies in Western Europe, according to premature baby charity Bliss.
Because of the difficulty involved in being able to predict whether babies aged between 23-24 weeks will live, die or survive with disabilities, the council has recommended that parents, after thorough consultation with doctors, have the final decision.
After 25 weeks gestation, babies have a sufficiently high chance of surviving and a low risk of severe disability, and intensive care should be given, the council found.
The report also gives guidance on abortion decisions in pregnancy, when an abnormality becomes apparent. Under the Abortion Act 1967, pregnancies can be terminated up to 24 weeks.
The Royal College of Obstetricians and Gynaecologists has called for an open discussion on the ethics of euthanasia for the sickest babies.
In its submission the college urged the council to think radically about euthanasia of newborns and withholding treatment in the face of severe disability.
Paul Tully, the general secretary of the Society for the Protection of Unborn Children, said that he feared the report's recommendations could encourage moves towards euthanasia for disabled babies.
Dr Tony Calland, the BMA’s Chairman of the Medical Ethics Committee had a similar view, stressing the importance of individual cases.
"Blanket rules do not help individual parents or their very premature babies," he said.
"Each case should be considered on its merits and its own context. While we believe that not all patients – including babies – benefit from medical intervention if survival is unlikely, it is important that each patient’s circumstances are assessed independently. We therefore cannot agree with stringent cut-off points for treatment."
