Active Euthanasia for Perinatal Osteogenesis Imperfecta; An Ethical Dilemma in a Tertiary Facility in Southwestern Nigeria: A Case Report https://doi.org/10.60787/NMJ-64-5-347

Main Article Content

Michael Abel Alao
Oluseye James Sobande
Ayodeji Matthew Borokinni
Abimbola Ellen Akindolire
Adejumoke Idowu Ayede
Olukemi Oluwatoyin Tongo

Keywords

Osteogenesis imperfecta, euthanasia, ethical dilemma, end of life, case report

Abstract

Managing a newborn with lethal congenital anomalies is challenging but handling a parent’s request for doctors under oath to terminate the baby’s life is another major ethical dilemma requiring cautious evaluation. We present a term male neonate who presented on the 7th day of life, with a dark-blue sclera, multiple limb deformities, long bone fractures, beaded ribs, a flattened forehead, a narrow chest, and respiratory distress. A Diagnosis of Type II Osteogenesis imperfecta was made and he was managed by a multidisciplinary team including neonatologists, geneticists/endocrinologists, orthopaedic surgeons, nurses, and medical social workers. Supplemental oxygen, intravenous fluids and antibiotics, analgesia, and bisphosphonates were offered as supportive care. The main concern was the challenges of managing a newborn with lethal OI and balancing the demand for euthanasia by the parents to end the baby’s misery. In providing care, the rights of the child to life, the morals of the physician, the best interests of the baby, and the family's role in decision-making in a setting of out-of-pocket expenditures must be weighed. Following extensive multidisciplinary team meetings, it was ultimately decided to allow nature to take her course. Baby subsequently had progressive respiratory distress from pulmonary hypoplasia and died of respiratory failure on the twelfth day of life. In Conclusion, Osteogenesis imperfecta of the perinatal type is usually a lethal disease, with death often occurring within the perinatal period. The physician must, therefore, balance the parental rights, the oath of office, and the existing legal framework to avoid charges of murder or manslaughter.

Abstract 39 | PDF Downloads 38 EPUB Downloads 15 HTML Downloads 15

References

1. Kon JJ, Verhagen A, Kon AA. Neonatal Euthanasia and the Groningen Protocol. in Pediatric Ethics: Theory and Practice: Springer, 2022:291-311.

2. Ayadi ID, Hamida EB, Rebeh RB, Chaouachi S, Marrakchi Z. Perinatal lethal type II osteogenesis imperfecta: a case report. Pan Afr Med J. 2015;21:11. doi: 10.11604/pamj.2015.21.11.6834.

3. Wach B. Dutch protocol from Groningen (the so-called Groningen Protocol). The problem of deliberate causing of death in newborns (“neonatal euthanasia”). Analiza i Egzystencja. 2020;49:53-87.

4. Losonczy LI, Papali A, Kivlehan S, Calvello Hynes EJ, Calderon G, Laytin A, et al. White paper on early critical care services in low resource settings. Ann Glob Health. 2021;87(1):105. doi: 10.5334/aogh.3377.

5. Lim J, Grafe I, Alexander S, Lee B. Genetic causes and mechanisms of osteogenesis imperfecta. Bone. 2017;102:40-9.

6. Rumack C, Johnson M, Zunkel D. "Antenatal diagnosis of osteogenesis imperfecta Clinical Diagnosis with Ultrasound. 1981;8:210.

7. Alao MA, Ibrahim OR, Ogunbosi BO, Nna EO, Olapegba PO. Effectiveness of Faith-Based Interventions on the Rate of Discharged Against Medical Advice in Tertiary Newborn Units in Nigeria: A Protocol for an Open Label Randomized Control Trial. Front Public Health. 2021. 2022.1;9:788383.

8. Monsudi KF, Oladele TO, Nasir AA, Ayanniyi AA. Medical ethics in sub-Sahara Africa: closing the gaps. Afr Health Sci. 2015;15(2):673-81

9. Nigeria's Constitution of 1999, available at https://www.constituteproject.org/constitution/Nigeria_1999.pdf, accessed on 23/11/2022.

10. Alves D, Costa ED. The Groningen Protocol for neonatal euthanasia: Our perspective. Nascer e Crescer - Birth and Growth Medical Journal. 2019;28: 185-190.

Most read articles by the same author(s)