To gain some idea of the kinds of issues that come up in this area it is worthwhile considering the celebrated but tragic case of Baby Doe. Baby Doe was the fictional name of a child born in 1982 in Bloomington, Indiana. The baby was a Down’s syndrome child with severe internal complications such as the lack of a passage from mouth to the stomach and the lack of any connection between windpipe and gullet. The baby also suffered from heart and other problems. The parents refused the offer of corrective surgery for Baby Doe and their right to do this was supported by the Indiana Supreme Court. The case raised a great deal of controversy and President Reagan subsequently instructed the Department of Health and Human Services to inform US hospitals that they would not receive Federal health care funds if they refused treatment to severely handicapped children. The rationale for this action was a section of the 1973 US Rehabilitation Act which forbids Federal funding of any programs which do not give equality of treatment to handicapped people. From this perspective, Baby Doe should have been given exactly the same treatment as any other newborn.
What we have here is a conflict between two radically opposed views. The first is that, as far as possible, all newborns, including gravely disabled babies, should be kept alive and that selective refusal of medical treatment should be prohibited. The life of a newborn child, no matter how disabled or handicapped it may be, is guarded by the ‘sanctity of human life’ doctrine, and the wishes of the parents or the prospects of the child are irrelevant. The second view is that parents should be able to refuse treatment for their children when it is clear that the treatment will not be for the long-term benefits of the child, given its handicaps and its almost non-existent possibilities a properly human life in the future. In this view the parents are acting as a proxy or surrogate for their child, and are, so to speak, exercising its right to choose not to have its life sustained (Kastenbaum, 2000).
A recent survey of the policies and practices of the eighteen Australian intensive care units for newborn babies has shown that they employ very different criteria regarding the refusal of life-sustaining care to newborns. Some take the view that disabled children or very premature babies with poor prospects have an absolute right to life and that the parents’ wishes about the child may be disregarded by the physicians. Others take the view that the parents should based on medical evidence, have the right to decide whether life-sustaining treatment should be given to their children. At present, it depends on which intensive care unit a baby cha to be in which determines what happens (Oates, 1997).
A further dimension has been introduced into this debate through the consideration of medical resources. In a recent article in the Medical Journal of Australia, members of a neonatal intensive care unit at the Royal Women’s Hospital in Melbourne have revealed that it is the unit’s policy not to offer full intensive care to newborns under 800 grams at birth, because (a) it is considered that they have extremely poor health prospects, and (b) it is considered that offering them full intensive care is not an effective use of the unit’s limited medical resources. (Neonatal intensive care costs something like $1000 per patient per day.) If very premature babies with limited prospects were given full care, then other babies with better prospects would not be able to receive adequate care (Kastenbaum, 2000).
One can, of course, avoid all the problems that arise about the artificial sustaining and prolongation of life simply by decreeing that biological life, as I have called it, has an absolute value, so that we have an absolute duty to preserve and sustain it. So, regardless of the fact that a cichlid may be born without a brain, we have a duty to keep it alive; regardless of the fact that a person may be severely brain-damaged and permanently comatose, we have a strict duty to keep that person alive by using whatever artificial means of life-prolongation we have; regardless of the fact that a person with terminal cancer may not wish to have his or her life prolonged, we must nevertheless refuse their wish and provide life-sustaining treatment for them even against their will. Those who support this position usually talk a great deal about the ‘sanctity of human life though human life was absolutely sacred and we had a positive duty to sustain human life in all circumstances. Some have even cited the Hippocratic Oath of the medical profession which forbids physicians from deliberately taking the life of a patient. (Oates, 1997).
Many formidable problems arise from the fact that we can thus artificially prolong the lives of severely disabled newborn children or people who have permanently lost consciousness, or terminally ill people facing a life of great pain or the complete loss of mental and physical control. In one sense these problems are not new, but there is no doubt that the new medical technology has exacerbated and dramatized those problems. As a result, there has been an enormous amount of discussion about the ‘right to die’, ‘dying with dignity, the ‘quality of life, and so on. In medicine, an area of ‘palliative care is now well-established and in the law, there is considerable interest in ‘living wills’ where people make a will specifying what medical treatment may be given to them in the event of their being incapable in the future of making a decision for themselves. There is also much interest in medical treatment legislation specifying the conditions under which patients may refuse medical treatment and so bring about their own deaths.
References
Kastenbaum, R. (2000). The Psychology of Death: 3rd Edition. Springer Publishing Company; 3 edition.
Oates, W. E. (1997). Grief, Transition, and Loss: A Pastor’s Practical Guide. Augsburg Fortress Publishers.
Dr. C. Everett Koop on Baby Doe, euthanasia, abortion. Youtube. N.d. Video clip. 2010. Web.