SOCIAL CONTEXT: The dilemmas of extreme Prematurity

SOCIAL CONTEXT: The Baby Doe Cases


Baby K: an Anencephalic Infant and a Mother's request 

Baby Owens: Down Syndrome and Duodenal Atresia

How to describe what occurred? 

What are the most important issues? 

Who decides who lives and who dies?

Who decides who is ,“Fit“ to live?

Based upon what criteria for “fitness“?

Why do they get to decide?

Who speaks for the  severely deformed newborns ? The impaired neonates?


Should they be given all possible treatments?

Should nothing be done and leave them to die?

Should they be killed quickly?

Who decides?  Based upon what criteria?

Genetic and Congenital Impairments: 

  • Down Syndrome

  • Spina Bifida

  • Hydrocephaly

  • Anencephaly

  • Atresia

  • Extreme prematurity

Specific Impairments

Testing for Impairments

  • Amniocentesis   12-14 weeks

  • Chorionic Villus Sampling  CVS   6-10 weeks

  • Genetic Screening

  • Blood Screening


Description of Trisomy 21-  Down Syndrome-“mongolism“

Mental impairment or alternative functioning

Physical abnormalities

Obstructions- deodenal or esophageal atresia



From the Reagan Administration: 

the Federal Emergency Medical Treatment and Active Labor Act (1986)

All institutions receiving federal funds (Medicare/Medicaid?other) must review those cases where there is DISAGREEMENT between the parent and the doctor.  An „Ethics Committee“  will review.  The committee consists of doctors, hospital administrator, ethician or theologian and community representative.  The committee reviews the condition of the child.  It does not consider the Quality of Life.  All that is to be considered is whether or not there are life threatening conditions all of  which could be alleviated.  If the case is such that all of such conditions can be removed then the committee is to order the procedures carried out.  If not all such conditions can be alleviated, then it need not order any to be done.  If there is NO DISAGREEMENT, then the case is not referred to the committee and WHATEVER is agreed to by the parent and the physicians will be done.  Thus neonates are left without food or water to die by severe dehydration or malnutrition.




INFANTICIDE: an ancient Practice!

Issue of Eugenics: the desire for the perfect baby

Technical Problem: the existence of technology for maitaining lives

Technical solution:

  • Genetic screening
  • Sterilization
  • Prenatal screening Amniocentesis, Chorionic Fluid Analysis, Sonograms
  • abortion
  • infanticide


No guarantees of perfect babies

Parents once had a sense of responsibility

Who decides the fate of those not "perfect" , of those not desired?

Adults:  those with prejudice 

Prejudice of the decision makers

  1. those who are well or not impaired
  2. those who have been raised with negative feelings towards the „different“

Children: without prejudice

People with differences , with disabilities, handicaps, challenges



Most common reasons: Appearance, sex, height

Most popular : sex  click here for reports of the practice Sex Selection-Infanticide



India Steps Up Effort to Halt Abortions of Female Fetuses


NAZI Germany

            The FINAL SOLUTION: eliminate threats to physical well being, the genetic pool, the economic fortune

            First with the malformed or defective neonates, then the defective children and adults, then the mentally ill, then to those not physically or mentally ill !




Who decides?  Who decides for those who can not decide for themselves?

Does Society have the right to intervene in the relationship of a parent to a child, of a Mother towards her Fetus? Neonate? Infant? Child?

If so, based upon what?  To what extent?  Who becomes responsible for the child?


Control over the evolutionary process:


Humans are the first species aware of its mortality and the first species aware of the evolutionary process.  Humans attempt to gain control over nature.  Humans are taking control over the process of evolution itself and are attempting to direct it.  Humans want to produce what they consider the "best" and this might not be the same as the most "fit" to survive.

Based upon what criteria?  Aesthetics?  Physical Appearances?

Humans appear to prefer cute to bright Looks over brains!

Consider what we once were:

Click here for a recreation of our ancestors: the first humans

We are much better looking now and taller and more physically adept.  Are we wiser?

What does it say about us as a species that we wish to control the evolutionary process by killing those of us we do not value?




A question of care: Ordinary versus Special Care versus being Allowed to Die

A question of personhood: Are neonates persons?  Are severely impaired neonates persons?

Utilitarian:  consider the costs (consequences) both economic and social

Kantian: if the neonate is a person then that person deserved respect and while it may be acceptable to refuse treatment it would not be acceptable to deliberately kill the infant.  If the infant is NOT a person, lacking in the ability to reason there would be grounds to allow the neonate to die.  There may even be a duty to do so. 

Natural Law: the neonate is a person and entitled to ordinary care to treat the curable life threatening conditions.  There are no grounds to withhold all care and no justification for killing a child, infant, or neonate.

Atheistic: For the incurable and life threatened neonate there may be  a withholding of treatment and a hastening of death.

Theistic: the neonate is a person and entitled to ordinary care to treat the curable life threatening  conditions.  There are no grounds to withhold all care and no justification for killing a child, infant, or neonate.



John A. Robertson The status of impaired infants

Infants are persons and entitled to care.   There is no way to evaluate and measure the total costs and consequences and so there should be no utilitarian justification for the withholding of treatment and care.

Tristam Engelhart: Aiding the Death of Young Children

1. Children are not persons.  Parents should make the decisions for those children along with the doctors caring for them.

2.  There is a duty NOT TO TREAT where doing so would only prolong the pain.

Robert Weir: Decisions in the Midst of Uncertainty

Infants are not persons but they are "potential " Persons and therefor have human rights.  All infants should be treated according to what is in their BEST INTERESTS and there are criteria for such determinations.  Parents and doctors should make the decisions considering ONLY the infant's interests.

Nancy Jecker and Roberta Pagon: Medical Futility

There are Quantitative considerations, when there is little chance of benefit and Qualitative considerations where the outcome is a poor one.  It is an example of INHUMANITY that causes or continues human suffering with no benefit and continues an existence that is not meaningful.

Norman C. Fost: Medical Futility  

"Futility" and "Inhumanity" are vague terms and arbitrary.  Such terms involve personal value preferences.  There is uncertainty concerning the diagnosis and prognosis for neonates.  The questions is whether or not LIFE is WORTH LIVING.  Medical doctors tend to medicalize a subjective value judgment.


The deliberate taking of the lives of newborns has been a practice for as long as humans have existed.  Does it bode well for us that we continue the practice?  Does infanticide raise or lower the value of human life?  Do we really make progress by deciding which of us are not "fit" or valued enough to live with us?