19 - The Forgoing of Life-Sustaining Treatment for Children

Summary

In antiquity, sick or disabled children were often left to die in the open, and even infanticide was not unusual up until the 20th century. These morally questionable practices were at least partly informed by the heritage of our Greek ancestors, who obligated physicians to not provide treatment of no perceived benefit. Hippocrates wrote:

Whenever therefore a man suffers from an ill which is too strong for the means at the disposal of medicine he surely must not even expect that it be overcome by medicine. [Treatment in such a situation was] … allied to madness.

And Plato in The Republic advised the physician:

For those whose bodies were always in a state of inner sickness he did not attempt to prescribe a regime … to make their life a prolonged misery … medicine was not intended for them and they should not be treated even if they were richer than Midas.

Following along with our rapid advancement in the biological understanding of human health and disease and our vastly improved ability to effectively treat “inner sickness,” our normative ideas about benefit, harm, and misery have evolved. Nowadays, because of an abundance of resources available in the most economically developed countries, it is often medicine's first instinct to try to save the seriously ill or disabled before we start to worry about contributing to unacceptable suffering or prolonging misery.