| READING:
Avoiding Anomalous Newborns
Author: Michael L. Gross
Publication Information : Journal of Medical Ethics,
August 2000 (vol. 26, no.4) 242-248.
Summary:
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
reevaluate”.
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) |