adapted

Ethics of Infanticide

Ethics of Infanticide• Biology/Philosophy 317: Biomedical

Ethics• Pattle Pun and David Fletcher


The case of Baby Owens• Born to Phillip and Dr. Joan Owens.

• 4.5 lb birthweight with Down Syndrome and Duodenal Atresia

• Allowed to die by parents because of quality of their life and that of their three other health children

• Refused consent to perform corrective surgery for Duodenal Atresia.

• Hospital staff did not pursue legal option of forcing parental consent.

• Baby Owens was let died by withholding treatment and food. Water was used to moisten her lips. She was shunned by physicians and most nursing staff.

• Criminal to accelerate her death.

• Care was given by a compassionate nurse to make her last days comfortable until she died after 12 days.


Ethics of Infanticide• About 150,000 babies are born each year with birth

defects. The parents of one out of every 28 babies receive the frightening news that their baby has a birth defect.

• A birth defect is an abnormality of structure, function or metabolism (body chemistry) present at birth that results in physical or mental disability, or is fatal. Several thousand different birth defects have been identified. Birth defects are the leading cause of death in the first year of life.

• Both genetic and environmental factors can cause birth defects. However, the causes of about 60 to 70 percent of birth defects currently are unknown.


Some common birth defects•

Spina bifida is the most common of a group of birth defects called neural tube defects (NTDs). It is among the most common severe birth defects in the United States, affecting 1,500 to 2,000 babies (one in every 2,000 live births) each year.

• Down syndrome is one of the most common genetic birth defects, affecting approximately one in 800 to 1,000 babies.

• Hydroceph: fluid buildup in brain; drainable with shunt.

• Anenceph: Absence of brain; usually fatal.


I. This is an ancient problem of bioethics: what to do when a baby is born with severe problems?

A. Aristotle: From man comes man, but sometimes a monster. Evidence of an irrational principle in the universe.

B., Both Plato and Aristotle advocated killing impaired newborns.

C. Ancient Greeks, Romans, many developing societies today: babies that are handicapped or unwanted for other reasons are simply left to die. Greek physician Sextus Empiricus wrote that Solon gave the Athenians the law that the father may slay his own child. The Twelve Tables of Ancient Rome (450bc), Table IV gave father right to kill his own child.


•Infanticide: the intentional killing of a newly or recently born baby. It has occurred in virtually every society. In some, infanticide is chosen because a male was preferred, or because it is less dangerous than abortion. In others, it was the desire to be free of deformed or unwanted babies and the fear of illegitimacy.


• Among the Eskimo, conditions of life were so severe that it was sometimes the practice to kill female children shortly after birth, lest there not be husbands able to support them.

• In Polynesia, Children also have been allowed to die or have been killed with cultural sanction because of irregular mating (such as incest or conception out of wedlock), or abnormal births,

• Religious offerings, especially of the firstborn, are known from the Bible, as well as from the histories of Egypt, Greece, and Rome. Firstborn sacrifice was once common among many peoples in India; here the motive was the offering of one's most precious possession to the deities

• Also, abandoning infants to the care of others (not placing for adoption, but dumping); Statistics from 19th century France suggest that up to 30 percent of all births were abandoned at foundling hospitals.


• China - Two researchers say comprehensive new data shows that traditional family patterns in China, combined with tough population-control measures, have resulted in ``female infanticide on a grand scale'' -- close to 800,000 baby girls abandoned or killed in a single region between 1971-80 alone.

The Los Angeles Times [in The Toronto Star, February 28, 1994.] According to census statistics, in rural India "From 972 females for every 1,000 males in 1901 ... the gender imbalance has tilted to 929 females per 1,000 males. ... In the nearly 300 poor hamlets of the Usilampatti area of Tamil Nadu [state], as many as 196 girls died under suspicious circumstances [in 1993] ... Some were fed dry, unhulled rice that punctured their windpipes, or were made to swallow poisonous powdered fertilizer. Others were smothered with a wet towel, strangled or allowed to starve to death."


•Today, Pro lifers estimate that infanticide, the purposeful neglect and outright killing of babies, claims between 2,000- 5,000 babies annually who have correctable defects such as spina bifida in the US.


Present Problems that raise questions of neonate survival

• About 6% of live births, or 200,000 per year, require intensive neonatal care.:

• A. Prematurity: birth weight is a good index of developmental immaturity. Extremely premature infants spent only about half the time in the uterus that they should; are really "fetal infants.“

• B. Severe immaturity: Every year almost 290,000 babies are born at least 6 weeks prematurely; 45000 are under 3.5 pounds, yet 85% survive and leave the hospital while 80% have major physical and/or mental impairments.


• Babies in the 500-700 gm range--that’s just over 1 lb.--over 50% survive, though with significant and irreversible neurological damage, including retardation and cerebral palsy

• 1. In the 1970s, most babies under 900 gm (2 lb) died. In the 1980s, babies below 700 usually died due to immaturity--underdeveloped lungs, digestive systems,cerebral hemorrhage

• 2. Cost; premature infants can run up hospital bills of at least $500,000.


UK, 2004• About 6,000 babies are born very prematurely (less

than 33 weeks of gestation) each year in the UK • About 2,400 babies die in the first four weeks of

life, each year in the UK • About 2,800 abortions a year are performed after

20 weeks of gestation • About 100 abortions a year occur at 24 weeks and

over • The cost of providing intensive care for a newborn

baby is up to £1,000 per day • 98% of all baby deaths in the world, occur in less

developed countries • The mortality rate for babies born in sub-Saharan

Africa is over 12 times that of the UK


Recent history

• In 1970s John Lorber, a British specialist in spina bifida, argued that some babies were so horribly deformed that it was better to let them die quickly rather than to survive. He developed criteria whereby the larger the affected area, the more likely there would be serious problems and the more likely it would be better to let them die. These criteria were widely accepted in Britain and the US.


• "Lorber criteria" employed for some years by pediatricians, pediatric neurologists, and neurosurgeons:

• A child born with one of these problems should be excluded from medical or surgical treatment:

1. advanced hydrocephalus, 2. total paraplegia, 3. scoliosis or kyphosis, 4. an associated anomaly.

In the British health system at that time, it was common to sedate these children, feed them only on demand, and essentially practice a form of "passive euthanasia." In North America about 2/3 survived but were even more disabled through lack of treatment.


Recent history

• Raymond S. Duff and AGM Campbell,“Moral and Ethical Dilemmas in the Special Care Nursery,”New England Journal of Medicine 289 (1973): 890-894.Reporting about the policy at the Yale New Haven Medical Center, where they were pediatricians:

• Of the 299 deaths occurring in a special care nursery in a two-year period, 43, or 14%, were as a result of a decision to withhold treatment. Included spina bifida child with multi organ anomalies and hydrocephalus, and a Down Synddrome child with other serious problems

• They had “increasing doubts about the wisdom of many of the decisions that seemed to parents to be predicated chiefly on technical considerations.”

• They decided to withhold care for some very impaired children, with full consultation with parents.


• In the 1980s, well publicized cases of Baby Doe (Indiana) (DS, needed esophagus opened) (1982, Bloomington) Courts upheld baby’s death. HHS treated these as discriminatory, barred institutions receiving fed funds from allowing to die.

• Bioethicist Louis Lasanga: We are perhaps more cruel to treat than the Romans were to let die.


• Baby Jane Doe Case (NY):

• October 11, 1983: Kerri-Lynn, Baby Jane Doe, was born in Long Island, NY, to Linda and Dan, a lower middle class Catholic couple. First child. Kerri-Lynn was 6 lbs, 20 inches long, with spina bifida with protuding meningocele, hydrocephalus, a damaged kidney, and microcephaly.

• Parents decided to give her only palliative care, food, fluid and antibiotics. Refused consent to drain the hydrocephalus.

• Pro life lawyer Lawrence Washburn filed suit to force treatment; got appointed guardian at litem. Another lawyer, William Weber, was temporarily empowered to make decisions regarding child’s care. Came to believe that child might have a normal brain, authorized surgery.

• Finally, parents decided to permit surgery to drain hydrocephalus. Took her home, where she remains in a wheelchair.

• In 1994, was reported on by B.D.Colen of Harvard U., who said that she was now “a ten year old, baby Jane doe is not only a self aware little girl, who experiences and returns the love of her parents; she also attends a school for developmentally disabled children---once again proving that medicine is an art, not a science, and clinical decision making is best left in the clinic, to those who will have to live with the decisions being made.”


• H. Tristram Engelhardt, Jr.• Ethical Issues in Aiding the

Death of Young Children• If being a person is to be a

responsible agent, a bearer of rights and duties, children are not persons in a strict sense... They are, as it were, entities defined by their place in social roles (for example mother—child, family—child) rather than beings that define themselves as persons, that is, in and through themselves.

• After becoming a Christian, he now subscribes to the dignity of human life and supports the treatment of defective infants.


Joseph Fletcher The Ethics of Genetic Control: Ending Reproductive Roulette

(1974) • “To repair and prolong

lives indiscriminately may be a kind of technical virtuousity but it is not control. To control means to choose and therefore any absolute morality about always keeping life going, before or after birth, regardless of quality considerations, is the very opposite of control and a denial of quality.”


• "If we compare a severely defective human infant with a dog or a pig ... we will often find the nonhuman to have superior capacities ... Only the fact that the defective infant is a member of the species Homo sapiens leads it to be treated differently from the dog or pig. But species membership alone is not relevant ... If we can put aside the obsolete and erroneous notion of the sanctity of all human life, we may start to look at human life as it really is: At the quality of life that each human being has or can attain."

• Peter Singer


• Judicial Council of AMA, in 1984, offered a policy statement that said “Quality of life is a factor to be considered in determining what is best for the individual.” Also that year, the Am. Acad. of Pediatrics offered a joint policy statement and offered what it called “very strict standards,” and said that the expected potential of an individual and the availability of resources are irrelevant and must not be used in treatment decisions.


• John A. Robertson• University of Texas

School of Law

• …Human parentage is a necessary and sufficient condition for personhood, whatever the characteristics of the offspring, because qualifying criteria inevitably lead to abuse and untold suffering to beings who are unquestionably human.


• In a brief submitted in a case in 1983, the Spina Bifida Association of America, a support and advocacy group for people wtih spina bifida, stated:

• “Since we have found it virtually impossible to predict at birth which infants with meningomyelocele will become competitive, ambulatory, and intellectually able, we have not relied on arbitrary guidelines to determine which children should or should not be treated. On the contrary we believe that all such children should be treated, and we feel that our data show this philosophy to be correct.”


• In that year, President Reagan signed the amendments to the Child Abuse Prevention and treatment Act, which would treat nontreatment decisions as child abuse, which the states must prevent.

• As Gregory Pence points out, Federal law does not make it a crime to withold treatment from impaired neowborns, but it threatens to withold all state funding for child abuse and prevention programs. No state has ever been found to be out of compliance.


Current controversies:

• UK in 2004. • Provoking an uproar, Professor John Harris, a

member of the British Medical Association's ethics committee and author of 15 books on the ethics of genetics, made the statement endorsing de facto infanticide during a recent debate over sex-selection, reports the London Telegraph.

• Asked what moral status he accorded an embryo, Harris responded by endorsing infanticide in cases where a child has a genetic disorder that remained undetected during pregnancy and suggested there's no moral difference between aborting an unborn baby and killing an infant once it's born, said the report.


• Netherlands, 2005

• “Drs. Verhagen and Sauer reported in the March 10, 2005, issue of the New England Journal of Medicine (NEJM) about the Groningen Protocol. This algorithm is used to avoid prosecution in the Netherlands when performing euthanasia on infants. The impetus for this protocol was not that physicians were being actively prosecuted, but that the authors felt that physicians failed to report acts of euthanasia in infants and children for fear of prosecution. The purpose of the protocol is to insure accurate reporting in order to “prevent uncontrolled and unjustified euthanasia” and to “develop norms regarding euthanasia in newborns.” Their publication in the NEJM is specifically intended to combat the “blood-chilling accounts and misunderstanding concerning this protocol.”


http://www.cbhd.org/resources/endoflife/beals_2005-03-24.htm

• The article summarizes 22 cases of infant euthanasia in the Netherlands. The authors outline the criteria by which they considered euthanasia, and how this process should be performed. A review of these cases raises several questions about the basis for considering ending these infants’ lives and even more ominous, includes only that small percentage of cases actually reported

• In every case, the prime, determining factor for euthanasia was quality of life. This was defined as having some functional disability or perceived potential to require long-term assistance (lack of self-sufficiency). Other factors included the inability to communicate verbally or dependence on medical care. These factors were considered to be the cause of suffering in these infants. The Netherlands’ laws concerning euthanasia find such action legally permissible in cases where a life of suffering cannot be alleviated by any means. By the authors’ reasoning, functional disability that cannot be completely abrogated is such suffering.”


Some Guiding Rules:• Exodus 22:22:• Don't mistreat widows or orphans.

• Micah 6:8• what GOD is looking for in men and women. • It's quite simple: Do what is fair and just to your neighbor, • be compassionate and loyal in your love, • And don't take yourself too seriously-- • take God seriously.

• Matthew 18:5, Mark 9:36,37, Matthew 18:6 • Jesus taught that the ‘welcoming’ of a little child in Jesus’ name was

equivalent to welcoming Christ himself and the Father who sent him.On the other hand those who caused a little child to ‘stumble’ would be punished severely.

• Mark 10:13-16, Matthew 19:13?16 • Jesus emphasized the importance of children and it is obvious that he had a

special affection for them. He rebuked his disciples for preventing children from coming to be blessed by him and went out of his way to make time for them..

Principles of Autonomy, Justice, Beneficence, Utility, Nonmaleficence? Human Dignity vs Social Responsibilities?