To know if a medical team did not share an "unreasonable obstinacy" to keep alive a newborn, is to be compared with the fight of this family of Nancy against the decision of the Council of State to validate the decision cessation of care of a 14-year-old girl, in a vegetative coma since June 2017, but that parents refuse to let die. A dilemma for the medical profession.
the facts go back to 17 years! In a clinic, a woman gives birth, by cesarean, to a child born the umbilical cord wrapped around the neck and in apparent death. The medical team, which included two doctors and nurses, then applied the protocol in case of cardiac arrest: about fifteen minutes of resuscitation maneuvers, which had resuscitated the child. Unfortunately at the cost of significant sequelae. The child is now moving in an electric wheelchair and his situation requires constant assistance.
"Was it legitimate to want to support this child? The lawyer asks. Some will speak of relentless treatment, others of strict application of the possibilities before a cardiac arrest.
the case is more recent: a teenager suffers from an autoimmune neuromuscular disease. She has been hospitalized since June following a serious heart attack that caused an old coma or "vegetative coma". Despite intensive care, and in the absence of improvement in his condition, doctors have found his case hopeless. In accordance with the End-of-Life Act of 2016, they initiated a procedure to stop treatment.
The father and mother of the teenager had seized in emergency ("in summary") the highest administrative jurisdiction to oppose the decision of the Administrative Court of Nancy, which had validated the proposal to stop the care of doctors. For parents, the decision of the court is to ask these doctors "to kill" ... An understandable interpretation, but a little abrupt.
According to the Council of State, "it is now up to the doctors in charge of the child to assess whether, and in what period, the decision to stop treatment must be executed."
It is not, indeed, to cause the end of life of the girl. Active euthanasia is prohibited in our country. It's about letting her die and therefore stopping supportive care. There is a very specific protocol, but it is difficult for a doctor to talk about a medical procedure, even if it should be.
The role of the doctor in the face of the disease
To give death is the opposite of the mission of a doctor. We perceive the dilemma. However, we must not be naive either ... For generations, doctors have been shortening - often in great solitude - the suffering of patients for whom there is no longer any hope, if not to prolong suffering. useless.
Should he decide to give up in the face of a lost fight or should he implement all the means of modern medicine?
For example, some countries have legislated and no longer open resuscitation services above a certain age - for example, 70 years in the Netherlands - unless there is explicit demand upstream. In France, the reflection on the resuscitation of very very premature babies has been going on for a long time and the limits are no longer crossed. Even though the record is very low: 226 grams after a 26-week pregnancy and a caesarean birth, because the mother's placenta no longer allowed her to live. Note that the child is still alive and was considered "normal" at 6 months.
The fear of the trial
For centuries, doctors have made the decisions in all confidentiality, and it is the repeated trials that have changed the game. Today, in the United States, most surgeries are filmed to prevent attacks by specialized law firms. Recall that in this country, the lawyer is financially interested by the outcome of the lawsuit.
It is difficult when working as a team, as is always the case in resuscitation, to make the decision not to go to the end of the possibilities of prolonging life, which are more numerous. It takes the conviction of a strong "boss" not to risk seeing one of the members of the medical team inform the family of these procedures that are not taught in any medical textbook.
This is probably a subject that the review of bioethics laws must address in the next 6 months.