Trump’s comments on late-term abortions are wildly misleading and false

“The baby is born. The mother meets with the doctor. They take care of the baby, they wrap the baby beautifully. And then the doctor and the mother determine whether or not they will execute the baby.”

Thus, President Trump grossly mischaracterized the painful complexity surrounding medical decision-making for infants with life-limiting conditions. And with these words, the president revealed his deep misunderstanding of the medical care of not just infants, but of all patients who are approaching the end of their lives.

{mosads}It can take physicians years of practice to understand that death is a part of life; sometimes, regardless of our hopes, wishes and best efforts, our patients die. In pediatric palliative care, we work every day to support children and parents facing serious illness through the course of their care. When a baby is born with a potentially life-limiting condition such as extreme prematurity or a congenital malformation, we help their parents navigate decision-making.

We explore their hopes, fears and values, to ensure that our medical system provides the care that is most consistent with their goals. Some families choose to attempt resuscitation and to pursue any available technological interventions for their babies.

These are loving parents. Other families chose not to pursue aggressive attempts at resuscitation, deciding that the burden of suffering outweighs the potential benefit to their child. These are also loving parents. Both pathways are emotionally fraught and deeply personal. Both pathways are valid. And both pathways involve excellent and intense medical care.

In none of these cases do we intentionally hasten death.

To be sure, some may argue that withholding interventions, for example not attempting resuscitation, is no different from actively killing a baby. For children with life-limiting conditions, current thinking in pediatric bioethics disagrees with that position. And clinicians who support the right of parents to forego potentially life-prolonging therapies agree that active killing of a child would and should, be illegal.

Yet this sort of decision-making is complex. The question is not simply whether a baby should live or die. Congenital life-limiting malformations encompass a spectrum of conditions and depending on the condition, prognostication can be incredibly difficult.

Likewise, individual values and goals vary widely from one family to the next, depending on myriad factors including faith, previous experiences and family structure. As a child’s medical status evolves and new information becomes available, it is only through the careful and ongoing exploration of goals that we help families navigate the choices available to them.

President Trump’s use of inflammatory and violent language in misrepresents the complexity underpinning these issues. He devalues the excruciating process families and medical teams go through to determine the best way to care for children. He disregards the immense suffering of parents navigating the most difficult days of their lives. And in doing so, he undermines the entire field of medicine, a guiding principle of which is “First, do no harm.”

Death ultimately comes for us all. For most, it comes in old age, hopefully peacefully. But the reality is that death also happens in childhood and even sometimes in utero or at the very moment of birth. In such situations, navigating decisions with parents is complex, deeply personal and should be guided by trained professionals in the most thoughtful and evidence-based way.

One father described this time, holding his dying infant, as the most “beautiful and terrible” of his life. We cannot allow these circumstances to be so blithely politicized, especially when the language is used that frames parents and clinicians as executioners. We have seen the dangers of allowing extreme and violent language to seep into the public discourse around many other issues and the end result is never good. We cannot allow that to happen here — in the most intimate and fraught moments of any parents’ life. We therefore denounce the president’s comments. His language of violence and his misrepresentation of good medical care cannot be allowed to pass unremarked, especially when the source is the highest office of this country.

Elisha Waldman M.D. is a pediatric hospice and palliative medicine physician in Chicago and the associate division chief of palliative care at Lurie Children’s Hospital of Chicago. Christine Bishop M.D. is an assistant professor of pediatrics, neonatology and the director or neonatal/perinatal Palliative Care at Wake Forest School of Medicine.