Editorial - Tuesday September 17, 2013

Peter Jackson, editor, The Northland Age

ONE of the real barriers to addressing what might broadly be described as social problems in this country is the refusal to accept that we are often the authors of our own misfortune. Many New Zealanders seem to have lost the ability to recognise even glaring links between cause and effect, and are increasingly becoming loathe to accept that at the end of the day, they are responsible for their own lives.

People who have made no effort to gain an education or skills that would make them employable blame others for the fact that they are uneducated and unemployed. Parents whose children are failing at school blame the education system for inherently disadvantaging their offspring. Those who choose grossly unhealthy lifestyles blame others for the fact that they are sick and the inability of others to cure them. In most cases it is the government's fault. Generations of social welfare have turned us into a people who expect 'them' to counter our shortcomings, lack of energy or stupidity, and when that doesn't work, as it generally doesn't, we have nowhere else to turn.

This has been exacerbated by authorities of all forms and at all levels. We have been encouraged to blame our woes on misfortune as opposed to any lack of effort on our part. Nothing, these days, is the fault of the individual. Almost any negative outcome, whether it be imprisonment, addiction, unemployment, poor health, can be blamed on someone else. Everyone in this country who has trouble abiding by society's rules, has abused their body to the point of dysfunction or has glided through life without acquiring a single skill of any value to an employer, is a victim. Whatever befalls us, someone else is to blame.

Nothing is immune from this debilitating philosophy, not even cot death, which some time ago became known as SIDS (Sudden Infant Death Syndrome), and has now morphed into SUDI (Sudden Unexplained Death of an Infant). Those acronyms are significant. The progress from cot death to SIDS might not have changed much, but SUDI is a different matter, at least in the breadth of its interpretation.

The problem is 'unexplained'. Infants continue to die for reasons that medical science cannot explain, but increasingly SUDI is being used to cover the deaths of infants by suffocation, in the great majority of cases as a result of sharing a bed with an adult or two. Such deaths might be sudden but they are by no means unexplained, and to label them as such is to absolve those responsible from blame. And now a Coroner has come out and said so.

Years ago, before the advent of the current coronial regime, Kaitaia Coroner Robin Fountain made a point of distinguishing between the accidental smothering of infants and genuinely unexplainable deaths. (Accidental because as far as the writer recalls no one was ever held criminally accountable.) Mr Fountain not infrequently gave the advice that is still being given regarding safe sleeping arrangements for babies, emphasising that it wasn't about money.

A small child did not have to have an expensive cot, but could be safely laid down in a drawer or even a cardboard box, providing it was well padded with appropriate bedding, and was warm and dry.

The last place, he and others said, that a baby should go down was in a bed shared by adults. The dangers of doing that were amply illustrated by the rate at which babies were smothering.

Health authorities these days seem reluctant to accept that there is a difference between an unexplained death and death by smothering, but Coroner Wallace Bain gave them a lead last week when he found that a two-month-old Bay of Plenty boy died of positional asphyxia as a result of "co-sleeping" with his parents. Like all co-sleeping deaths, he added, this death had been preventable. Hallelujah.

Mr Bain said he believed that around half the 55 to 60 SUDI babies in this country every year died as a result of sleeping with adults, and that every one of those deaths was 100 per cent preventable. In this case the child had been sleeping between his parents, and while he had his own tripillow it was likely that he had been disturbed by his parents, causing him to slip down, his face becoming covered by soft bedding. Babies of that age were only able to lift their heads for minutes before becoming exhausted; his face would have sunk into the pillow and/or bedding, resulting in asphyxia.

Mr Bain also noted that the mother had discussed unsafe sleeping arrangements with her midwife, who was aware of a history of alcohol and cannabis use. The midwife had sought an assurance that the baby would be sleeping in a cot. That did not occur, and the baby was dead, Mr Bain said.

He went further. He described "co-sleeping and the killing of innocent babies" as a form of child abuse, and undertook to recommend that the government consider "this form of child abuse" in its legislative reforms. He also called for repeat cases of co-sleeping in families to be addressed, saying those parents should have to prove they were fit to parent more children.

Another Coroner, Ian Smith, said last week after an inquest into the death of a week-old baby who was not breathing when her parents and a two-year-old sibling, who were all sharing a pull-out sofa, awoke, that too many parents continued to ignore warnings about co-sleeping. The parents of the infant had been advised about the safest way for her to sleep. A midwife had visited the home several times after the baby was born, and discussed "such matters" as sleeping arrangements.

It would not be too much of a stretch to regard the smothering of infants as manslaughter, even allowing for the probability that some people simply do not grasp even the basic fundamentals of responsible parenting. Certainly a case could be made for manslaughter in the event of more than one death by smothering within a family. The first step though is to start telling it as it is, to stop trying to ease the conscience of parents who, even if unwittingly, cause their children to die by adopting an inherently dangerous sleeping arrangement, especially if they have been warned against it.

Even to put such deaths down to unwitting behaviour is a sop. It is difficult to believe that the 30-odd children who reportedly smother in this country every year as a result of sleeping with adults, and one imagines the many hundreds who do so and survive, enter this world without the benefit of advice from midwives and other experts warning against that practice.

Unless the parents have severe short-term memory problems, and that's probably not entirely out of the question, there can be no excuse. Those whose babies smother because advice was ignored can hardly be seen as unwittingly responsible. They should be seen as the perpetrators of a tragedy, not as the victims of circumstances beyond their control.

Mr Bain could hardly have expressed his view more clearly than he did when he spoke of killing innocent babies and equated co-sleeping as a form of child abuse, and hopefully other authorities were listening. He may have taken us one small step towards accepting responsibility for our lives and the lives of those who depend upon us, and if so he will have done us all a favour.