Bioethics Blogs

Relaxed about dying?

“Now we must wait, wait. These hours…. The gurgling starts again — but how slowly a man dies! …By noon I am groping on the outer limits of reason. …every gasp lays my heart bare.” Erich Maria Remarque, All Quiet on the Western Front

In Remarque’s novel, the agony of the German soldier, witnessing the slow death of an enemy combatant, is heightened by his own guilt (the narrator had stabbed another soldier in self defense). However, his powerful evocation of distress (and guilt) at witnessing a slow dying is very close to the expressed concerns of parents and clinicians who are watching the death of a child.

In such circumstances would it be ethical for doctors to give drugs to stop a child’s gasping breathing?

New Dutch guidelines, described recently in the journal Pediatrics, specifically permit this option. In the Netherlands, in this situation, doctors will sometimes give the child a “muscle relaxant”. These are drugs that paralyse the child’s muscles. They stop the child’s breathing, consequently ending the child’s gasping, but also ending their life.

Why would such steps be needed? To understand this it might be helpful to describe what happens when someone (child or adult) dies.

When a child is in the last phase of dying, they lapse into unconsciousness. Their breathing often becomes irregular. They sometimes stop breathing and then start again after a long pause. Often children start to take deep, infrequent “gasps” that gradually become further and further apart, before stopping completely.  Such gasps are thought to be a basic (subconscious) reflex, arising deep in the brain-stem.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.