Chapter 9 :Severely Impaired Newborns and Infanticide


Avoiding Anomalous Newborns

Author: Michael L. Gross

Publication Information : Journal of Medical Ethics, August 2000   (vol. 26, no.4) 242-248.  


Michael Gross in his article “Avoiding Anomalous Newborns” lays out the
complexities of developing a public policy on avoiding anomalous
newborns. The complexity lies in achieving a balance between the ethical
and economic justification in dealing with anomalous babies. He examines
the case of baby Messenger born in United States in the light of two
protocols used in Denmark and Israel - meeting threshold criteria for
treatment (Denmark) and choosing late-term abortion (Israel). He claims
that either of these protocols can be adopted in the United States since
they both offer “feasible policy options” to deal with “the economic and
social expense of anomalous newborns”. Gross, however, recognizes the
challenges that an effort to implement such protocols in the United
States could face.  

 Baby Messenger’s case stirred a great deal of controversy on the
neonatal care and parental rights. The father in this case faced the
charges for manslaughter of the baby but the court later acquitted him.
Doctors predicted a 50-75% chance of mortality for baby Messenger and a
20-40% chance of having severe cerebral hemorrhage and neurological
damage should he survive. He weighed only 780 grams at birth from
twenty-five weeks gestation. The medical staffs ignored the request from
Messengers not to resuscitate their baby, which prompted the father to
take the matter on his own hands. Gross suggests that “modified
threshold” endorsed by Danish Council of Ethics could have been used as
a guideline in baby Messenger’s case. The “modified threshold” criterion
considers the minimum gestational age, a maturity criterion and respect
for parental wishes in deciding to put a baby in life support or not.
However, this guideline has its own risks. Some parents may decide to
take care of their baby even when the baby does not meet the threshold
or some other parents may want to withhold treatment from those meeting
it. This could result in deaths of some healthy babies.  

One often suggested alternative to “modified threshold” is “initiate and
reevaluate”, in which we resuscitate and then evaluate all the infants.
Americans generally like this alternative showing their concerns for
autonomy and individualism on neonatal care decisions. On the question
of autonomy, Gross suggests that modified threshold offers a gentler
autonomy to the parents by removing the active decision making from
their hands and relying on “presumed consent”. Gross states that the
issue of individualism becomes void in neonatal care because “health
care systems are designed not only to provide life for greatest number
but also quality of life for the greatest number.”  Gross questions how
this alternative, “initiate and reevaluate”, could be better than
“modified threshold”. He argues, “Reevaluation and subsequent treatment
decisions are based on probability figures no less than the decision to
deny treatment at birth”. His concern is for how long we should
reevaluate an infant before reaching to a “certainty” and says during
that waiting period we are creating a large pool of handicapped
children. Gross concludes that “modified threshold” is more
cost-effective and ethically compelling policy than “initiate and

The second half of Gross’s article deals with the late-term abortion, a
widely used protocol in Israel. In the United States, we define abortion
as the “expulsion of an embryo or fetus before it is viable”. Israel on
the other hand defines abortion as “terminating a pregnancy”, which
makes even third term abortions possible as long as it is approved by a
hospital board. In a case like Messenger, people in Israel would have
sought a pre-emptive abortion. A fetus does not get the status of
“personhood” under Israeli laws until it is born. Once born, however,
Israel treats every viable infant, since it then follows a protocol that
reflects, “treat until certainty”.  In the United States, the Supreme
Court protects the unborn fetal life to a degree to which it does not
protect the new born. Gross says there is no difference between a
late-term fetus and an early-term infant. Therefore, we should treat
them equally. However, the countries like United States, United Kingdom,
and Denmark allow withholding or withdrawing treatment from a new-borns
but do not allow late-term abortions.  

One issue that often people find difficult coping with is the method
used to terminate a fetus. They consider it “active euthanasia”. He says
that many people may find terminating a fetus even with a lethal
injection in the best interest of the fetus, especially if the fetus is
afflicted with diseases like Tay-Sachs or Lesch Nynan syndrom. However,
many nations would consider injecting a lethal injection to similarly
afflicted newborns a murder. This suggests that in people’s mind a fetus
has an inferior status than a newborn, which itself justifies fetal
termination by lethal injection. Gross comments that if it is acceptable
to terminate a fetus through lethal injection in some cases, then it
opens way for considering the same for newborns.  

Gross in his concluding remarks says that pre-emptive abortion and
threshold protocols provide a “feasible policy options” with a balance
of ethics and economics that can be put on the public agenda.
Summary: Hita Gurung (QCC, 2003)

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