Page 7 - American Nurse Today January 2008

The
Babies Doe: Finding middle ground
When a baby is born with profound birth defects, the choice doesn’t have to be between dehydration and futile treatment.
By Leah Curtin, DSc(h), RN, FAAN
THE FAMOUS BABY
DOE case involved a
baby born with a tra- cheoesophageal fistu-
la and esophageal
atresia. The baby’s
parents and physi-
cians opted not to
correct these incom- patible-with-life de-
fects because the ba-
by also was born
with Down syn-
drome. Another Baby
Doe born with a se-
vere meningomyelo-
cele was deprived food and water at her parents’ request and with the physician’s approval even though she could take food by mouth.
Both babies died of dehydration, but the first baby’s dehydration re- sulted from birth defects. The sec- ond baby’s dehydration was induced by the parents and physicians.
These cases raise complex issues: • Because the first baby was born
with lethal though correctable defects, the parents were al- lowed to decide whether their child with Down syndrome would live or die. Are mentally handicapped newborns entitled to the same care and treatment as infants born without a mental handicap? If not, what does this
mean for people at any age who have Down syndrome or any condition that impairs mental function?
• If a decision not to treat such in- fants is acceptable, how does one justify using dehydration in- stead of more merciful means?
• When medical or surgical inter- vention offers no meaningful hope for life, what options are— or should be—available to par- ents and professionals?
Philosophical foundations for infanticide
The usual arguments for mercy killing, non-treatment, and direct killing of adults don’t apply to neonates. The crux of the argument
for mercy killing, non-treatment, or di- rect killing of infants is that, handicapped or not, they aren’t fully human. Thus, killing them isn’t the equivalent of killing a human. But because they are potentially human, neonates aren’t without value, and their killing should be neither random nor arbitrary.
This line of think- ing started with Joseph Fletcher’s
1972 article, “Indicators of human- hood: A tentative profile of man,” and has been augmented by the work of several philosophers. Fletcher’s criteria for “humanhood” include:
• minimal intelligence (an IQ of 40 is questionably human, an IQ of 20 is nonhuman)
• self-awareness
• self-control
• a sense of time
• a sense of futurity
• a sense of the past
• the capability to relate to others • concern for others
• communication
• control of existence • curiosity
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