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A premature baby born at the end of August died Friday after having been at the center of media controversy over his parents’ request that he should be allowed to die because they feared raising a handicapped child. Titouan, a little boy, was born at 22 weeks gestation, in the “danger zone” where survival is possible but frequently associated with handicaps and brain damage related to the child’s insufficient development at birth.

As medical science and practice progress, premature babies are increasingly being saved from the certain death that awaited them not so long ago, but this has brought with it new problems and ethical questions: how far should medical teams go when there is no hope at all for anything but a heavily handicapped existence, when death would almost certainly ensue if no invasive means were used?

In most cases – and they are not infrequent in French hospitals where neonatal teams usually do the utmost to save a premature baby at birth – the child’s family and the medical team will find an answer together: either to go on with the resuscitating techniques, or to abstain from these therapeutic acts.

In the case of Titouan, the parents, Mélanie and Aurélien, both in their thirties, went public about their opposition to the doctors’ decision to “save” their little boy despite the fact that they had clearly stated that they did not want a handicapped child. “Who wants their son to live the life of a handicapped person? Perhaps some families want this, but we don’t,” they said during emotional interviews that were given wide coverage.

They also pleaded for the doctors to “put an end to his suffering,” claiming that their baby was experiencing pain and discomfort because of the treatment he was receiving in the neonatal intensive care unit. “They couldn’t care less about his pain,” said Mélanie, tearfully.

The press was quick to link the story to the ongoing euthanasia debate in France, which is expected to come to a head before the end of the year when the socialist government will present a new “End of Life Act.”

At the Poitiers University hospital where Titouan was born, the medical team refused to “unplug” him as long as there was no certainty about the way he was responding to treatment. He was not under “invasive” treatment, they said: the little boy was being “accompanied.” Having consulted together and with an outside expert as the law requires, they underscored that there was no reason to make a hasty decision. A neonatologist from Bordeaux, Dr. Christophe Elleau, went so far as to say: “Sometimes it is urgent to do nothing. It is never urgent to kill, especially since it’s irreversible.”

This comment added substance to the idea that the only options in Titouan’s case were to keep him alive using exaggerated means or actively to make him die. So is that what doctors are doing every time they do not use every possible technique to keep a premature baby alive, at any cost?

When the little boy’s parents went to the media about their son’s case, a week before his death, Titouan had experienced brain hemorrhage which might leave him partially paralyzed, according to the parents who accused the medical team of “lying” about the gravity of his potential handicaps in order to force them into accepting that he should live.

Thursday evening, a week later, in the face of his actual condition, which had “worsened” considerably in a few hours, the medical team at Poitiers decided that continuing treatment would now constitute “unreasonable obstinacy” as the law puts it, and in accordance with Titouan’s parents, they were prepared to “accompany” his end of life.

While no details were given about the way things went, this would probably mean stopping artificial ventilation at a point where most probably the boy would not start breathing on his own, while giving him palliative care to avoid suffering.

This is not euthanasia: there is no question of positively provoking the death of the little patient, but of letting nature take its course. Should he have lived despite the medical abstention, his life could have been respected and he would have received treatment.

Dr. Alain de Broca, a pediatric neurologist and a specialist in medical ethics and palliative care at the University Hospital of Amiens, told LifeSiteNews that in cases like Titouan’s, it is important to stress that “it is not the doctors who put an end to life, it is the condition or the illness” itself. The question is not, for instance, of withholding food and fluids in order to obtain death.

“Very premature babies’ brains are like parchment,” he said. “As they mature, the very process provokes hemorrhages that can be of varying degrees of gravity. In many cases they will be resorbed and the baby will recover to become a healthy, normal, mischievous child. In others, the brain will suffer severe or very severe damage. Then extreme techniques will bring no benefit. It is not so much a question of stopping treatments that arises, as that of taking the decision not to put them in place. In fact, in these situations, it is every day, as they evolve, that doctors will decide in accordance with the parents to ‘reiterate’ a resuscitation treatment or no. We must come to terms with the fact that we do not have therapeutic omnipotence.”

He added that it is important for parents to be closely associated with the decisions that are made, and that they should be helped to understand that at a certain stage heavy treatment would only artificially prolong life. In other cases the same treatment sustains life. But in all cases decisions cannot be made “without the parents” who must realize that the child is in no sense being put to death. De Broca made clear that abstention from “obstinate means” in the case of very premature babies is in no way comparable to neonatal euthanasia as exists in the Netherlands, either by direct killing or withdrawal of food and fluids.

The debate is in fact not about euthanasia but about overaggressive medical treatment, which is not required when a patient is in very bad shape and would die because of his condition if sophisticated techniques were not used, as in the case of a cancer patient who can legitimately refuse heavy chemotherapy that would make him suffer with little hope of betterment. Not, however, before the disproportion of the treatment is clearly evidenced.

Unfortunately this is not the way the debate has been presented in the French media.

Alain de Broca made clear that respect for a premature or very ill baby’s life, until the very end, is very important for all those who are affected by the tragedy of his short existence. He stressed that the decision to deliberately shorten such a life has dire consequences for the baby’s near ones. “A few extra days of life can mean a lot, allowing parents, aunts, uncles, grandparents to come and see the child, fondle it, let it find its place in the family history,” he said. That will make healthy mourning possible: it is easier to come to terms with bereavement when a dying child has been surrounded, accompanied and cared for. “It is not possible to say goodbye properly to a child who has not been properly welcomed,” de Broca said. “When that is not the case, mourning will most often be pathological.”

“Each day of the child’s life is important,” he concluded. “I have accompanied many cases: very often, the child dies in the parents’ arms. And that helps them come to terms with the folly of its death.”

All this does leave a paradox unexplained: while in France, neonatologists will frequently use extraordinary means to try to save the lives of the tiniest of babies – Titouan weighed under two pounds – “medical abortion” is permitted and performed up to the very end of pregnancy for much lighter handicaps than those premature babies are exposed to.