CHICAGO - It's a situation too agonizing to contemplate - a child dying and in pain. Now a small but provocative study suggests that doctors may be giving fatal morphine doses to a few children dying of cancer, to end their suffering at their parents' request.
A handful of parents told researchers that they had asked doctors to hasten their children's deaths - and that doctors complied, using high doses of the powerful painkiller.
The lead author of the study and several other physicians said they doubt doctors are engaged in active mercy killing. Instead, they speculate the parents interviewed for the study mistakenly believed that doctors had followed their wishes.
A more likely scenario is that doctors increased morphine doses to ease pain, and that subsequent deaths were only coincidental, said lead author Dr. Joanne Wolfe, a palliative pain specialist at Dana-Farber Cancer Institute and Children's Hospital in Boston.
The American Medical Association, American Academy of Pediatrics and most other mainstream doctor groups oppose mercy killing but say withholding life-prolonging treatment for dying patients can be ethical.
Dr. Douglas Diekema, a medical ethicist at Seattle Children's Hospital, said the study results are not surprising.
"I have no doubt that in a small number of cases, some physicians might cooperate with a parent's desire to see a child's suffering ended. This might include giving a drug for sedation or pain control that also suppresses the drive to breathe.
"Most physicians don't intentionally push that drug to the point of stopping a child's breathing, but some may be comfortable not intervening if a child stops breathing in the course of treating him or her for discomfort," Diekema said.
The study was published yesterday in the March edition of Archives of Pediatrics & Adolescent Medicine. It was based on interviews with parents of 141 children who had died of cancer and were treated at three hospitals, in Boston and Minnesota.
Among parents studied, one in eight, or 13 percent, said they had considered asking about ending their child's life, and 9 percent said they had that discussion with caregivers. Parents of five children said they had explicitly requested euthanasia for their dying children, and parents of three said it had been carried out, with morphine.