Kerstin Knight

Based on an analysis of a case study from a Victorian case of neonatal hypoxic ischaemic encephalopathy (HIE), I want to propose that in some circumstances it would be desirable to have well-regulated legal provisions, such as the Groningen Protocol (GP), to hasten the death of newborns with catastrophic health conditions in order to reduce suffering. My argument will take the following form: (1) Neonatal euthanasia in form of withholding all (including natural) nutrition and hydration is already practiced in Victoria and considered legal in circumstances of palliative care. (2) In cases where it is already legally practiced, there are better and worse ways to achieve a good death. Ways that result in less suffering, all else being equal, are morally superior and therefore preferable. (3) Lethal injections that result in a painless, controlled death are better than starvation, because it causes less suffering. Therefore, in cases where death as the palliative outcome is either aimed at or unavoidable, injection of a lethal medication is preferable to slow starvation. In well considered circumstances it should therefore be a legal treatment option and considered best practice.

Advance care planning (ACP) is promoted as beneficial practice internationally. This article critically examines different ways of understanding and measuring success in ACP. It has been 50 years since Luis Kutner first published his original idea of the Living Will, which was thought to be a contract between health carers and patients to provide for instructions about treatment choices in cases of mental incapacity. Its purpose was to extend a patient's right to autonomy and protect health carers from charges of wrong-doing. Yet, it can be doubtful whether different types of ACP achieve these goals rather than aiming at secondary gains. My discussion suggests that the current promotion of ACP is not always engaging critically with the original ACP intentions and may even pursue notions of success that may run contrary to respecting autonomy. The risk of this may especially be the case when high participation rates are taken as indicators of success for institutional ACP programs. I further suggest that Kutner's two original aims of protecting patient autonomy and preventing charges of wrong-doing are near impossible to achieve in conjunction, because their simultaneous pursuit fails to acknowledge that patients and carers have opposing needs for reassurance about possible judgment errors. I conclude that the most realistic idea of success of modern ACP is an acknowledgement of the importance of ongoing dialogue about what constitutes appropriate care and a diversity of aims rather than any kind of advance, contractual insurance in the face of controversy.