The Acceptabilityamong Lay Persons and Health Professionals of Actively Ending the Lives of Damaged Newborns
Résumé
Background: Euthanasia is performed on occasion, even on newborns, but is highly controversial,
and it is prohibited by law and condemned by medical ethics in most countries.
Aim: To characterise and compare the judgments of lay persons, nurses, and physicians of the
acceptability of actively ending the life of a damaged newborn.
Methods: Convenience samples of 237 lay persons, 214 nurses, and 76 physicians in the south
of France rated the acceptability on a scale of 0–10 of giving a lethal injection in 54 scenarios
composed of all combinations of 4 within-subject factors: gestational age of 6, 7, or 9 months;
3 levels of severity of either perinatal asphyxia or of genetic disease; attitude of the parents
about prolonging care unknown, favourable, or unfavourable; and decision made individually by
the physician or collectively by the medical team. Overall ratings were subjected to cluster analysis
and each cluster to analysis of variance and graphic representation.
Results: Lay persons (mean acceptability rating 4.29) were significantly more favourable to euthanasia
than nurses (2.84), p<.005, or physicians (2.12), p<.005. Five clusters were found with
different judgment rules, i.e., how the information was integrated. More physicians (30 per cent)
than nurses (14 per cent), p<.01, or lay persons (11 per cent), p<.01, rated euthanasia as never,
under any condition, acceptable. Most, however, asserted that it was increasingly acceptable
as the factors combined to favour it, especially when the parents desired to stop treatment. More
physicians (45 per cent) and nurses (46 per cent) than lay persons (21 per cent), p<.01, used a
complex conjunctive rule (level of parent’s attitude x level of severity of damage x consultation
with team or not) rather than a simple additive rule.
Conclusions: Unlike law and medical ethics, most of the lay persons, nurses, and physicians
judged the acceptability of euthanasia as a function of the circumstances. Most health professionals
combined the factors in a conjunctive (multiplicative), rather than additive, fashion in
accordance with legislation for adults in the Netherlands and elsewhere that requires a set of
criteria to be fulfilled before it is legitimate to end a patient’s life.