Using the pain principle to provide a new approach to invasive treatments and end-of-life care

End-of-life issues involving small babies are particularly challenging for doctors, particularly pediatricians as there are complex issues involved, including long-term disabilities (1) and the parents' wishes (1). Evaluations can be based on statistical risks (2) and case-by-case issues. Some authors (3) suggest that intensive care can be withheld when consciousness is compromised, but that raises questions about what level of consciousness equates to a baby being completely compromised (4). Other authors have questioned whether suspending therapies when the baby is not at their end-of-life is ethically right. Concerns have also been expressed that there is a risk that babies lives are undervalued, in comparison with older patients, because their life support is removed more easily than when adults have a similar prognosis.