SOC 573 - Infant Euthanasia

1
SOC 573 - Infant Euthanasia

• James G. Anderson, Ph.D.

2
Medical Advances

• In 1984 25 of extremely low birth weight babies
  survived at least two years.
• By 1994 50 of extremely low birth weight babies
  survived at least two years.
• Through aggressive measures, babies with a birth
  weight of 1000 grams (2 pounds 3 ounces) have a
  good chance of surviving.
• Today babies weighing as little as 600 grams (1.3
  pounds) may survive.

3
Curbs on Rights of Parents to Decide

• Right-to-Life Groups
• Advocates for the disabled
• Federal law that states that it is neglect to
  withhold life-sustaining care unless treatment
  appears altogether futile or the child is
  permanently unconscious.

4
Other Factors

• Insurers and hospitals rarely balk at high cost
  of care.
• Courts are reluctant to order a halt to treatment
  if a parent or physician wants to continue care.

5
Other Factors

• Courts have ruled that doctors must base
  treatment decisions on an assessment of the
  childs best interest, but it is not clear whose
  opinion must prevail.
• Neonatalogists argue that early aggressive
  treatment is warranted because they dont know
  how an infant will respond.

6
Case

• In 1994, the U.S. Supreme Court refused to
  consider a case in which an appeals court had
  ordered continued life support for a Virginia
  girl born without most of her brain. Her mother
  fought the hospitals efforts to terminate life
  support. The appeals court ruled that treatment
  was required even though the doctors considered
  it medically and ethically inappropriate.

7
Case

• In Cicero, IL , house painter, Rudy Linares,
  removed life support from his 15-month-old son
  while holding off hospital staff with a gun. A
  grand jury refused to indict him on murder
  charges and the state dropped the case.

8
Case

• About an hour after the premature birth of their
  third child, Greg and Traci Messenger, shut the
  door to the room and removed their 1 pound 11
  ounce boy from the life support system. The
  sound of the automatic alarm brought a doctor and
  nurse running to the room , but too late. Cut
  off from its oxygen supply, the infant died. His
  father, a dermatologist, now faces prosecution
  for manslaughter.

9
Types of Cases

• Babies born with a genetic defect, Downs
  Syndrome, which causes mental retardation. Some
  of these babies have defects of the heart and
  esophagus which must be treated by surgery or the
  baby will die.

10
Types of Cases

• Babies born with neural tube defects where the
  spinal cord has not closed during fetal
  development (e.g., spina bifida) some cases are
  severe and include mental retardation others are
  minor. The lesion must be closed surgically or
  the baby will die of infection

11
Types of Cases

• Babies born prematurely some congenital or
  inborn birth defects may be present. Often the
  babies main problem is that their organs,
  particularly their lungs, are too immature to
  sustain life.

12
Conditions for Withholding Life-Prolonging
Interventions

• Extended life is judged not to constitute a net
  benefit to the infant.
• It is believed that the infants condition is
  such that the capacities sufficient for a minimal
  independent existence of personhood can not be
  obtained.
• The cost to other persons, especially parents and
  family, are sufficient to overcome customary
  duties toward the infant.

13
Survey of American Academy of Pediatrics Surgical
Section

• 80 did not believe that the life of each and
  every newborn infant should be saved if it is
  within the ability to do so.
• 23 would ask the parents not to consent to
  surgery and to allow the physician to decide if
  an infant with Downs Syndrome also had an
  intestinal obstruction.

14
Survey of American Academy of Pediatrics Surgical
Section

• 50 would provide the parents with all known
  facts and would allow the parents to decide if an
  infant with Downs Syndrome should have surgery
  for an intestinal obstruction.
• 8 would acquiesce to the parents decision to
  refuse surgery for an infant with simple
  intestinal atresia.

15
Questions

• How accurate is the prediction of outcomes?
• Is there an accepted level of quality of life?
• Does it make a difference if treatment is not
  initiated or it is stopped?
• Who should decide?

16
Questions

• Whose interests are the parents serving?
• Who should bare the costs of the decision?
• If we permit infants to die without treatment,
  have we started on a slippery slope?