READING_ Robertson

Chapter 9 :Severely Impaired Newborns and Infanticide

READING: 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.

Outline by Don Berkich, University of Texas, Corpus Christi (by permission)

Robertson criticizes three arguments which might be put forward to show that severely deformed infants do not have a right to ordinary but necessary medical care. His strategy is that of defeating arguments against a severely deformed infant's right to ordinary but necessary medical care so as to argue for the presumptively true thesis that the vast majority of severely deformed infants do have a right to ordinary but necessary medical care.

To understand Robertson's strategy it is important to understand the concept of the burden proof:

The concept of burden of proof is ordinarily a legal one. But it does have application in philosophical discourse. Suppose I claim that the moon is made of green cheese. Then, given everything else we know, it is reasonable to say, "prove it". In other-words, I bear the burden of proof. Since there is a presumption that what I have said is false, I have to give an argument to show that the moon is made of green cheese. Now suppose I give just such an argument. The presumption, again, is that the moon is not made of green cheese. So I bear the burden of proof. If my argument is sound, then I've satisfied my burden of proof. But if you somehow show that my argument is unsound, then you've shown that I've failed to bear the burden of proof and the presumption remains that the moon isn't made of green cheese.

Now, with respect to Robertson's article the presumption is that infants, even severely deformed infants, have a right to medical care. So those who argue that they don't bear the burden of proof. In this article Robertson is taking the role you did in showing that I failed to bear the burden of proof for showing that the moon is made of green cheese, except here Robertson is arguing that those who have argued that not all infants have a right to medical care fail to bear the burden of proof. If he is correct, then the presumption returns to all infants having a right to medical care.

Robertson succeeds in showing the first two arguments he tackles unsound, but his assertion that disutility can be minimized is unconvincing--it's not at all clear that he's shown the third argument unsound.

Argument I	1	Only persons have a right to ordinary but necessary medical care.
	2	No severely deformed infant is a person.
Therefore	3	No severely deformed infant has a right to ordinary but necessary medical care.	1&2

Let us be very clear: Robertson is not putting this forward as an argument he thinks is sound. Just the opposite: Robertson is putting forward this argument so as to show why it is unsound.

Robertson's strategy is to show that premise (2) has unacceptable consequences and so ought to be rejected (for most cases).

Robertson's criticism: Let R = If x is conceived and born of human parents, then x is a person.

	1	No severely deformed infant is a person.
	2	If no severely deformed infant is a person, then R is false.
Therefore	3	R is false.	1&2

So here we have it that premise (2) of Argument I implies that R is false. But why should that be a problem? Because if history is any guide the idea that being born of human parents is not enough to make one a person leads to astonishing abuses. Thus

	1	If allowing exceptions to a rule is subject to significant abuse, then exceptions may not be allowed to that rule unless they can be justified beyond reasonable doubt.
	2	Allowing exceptions to rule R is subject to significant abuse.
Therefore	3	Exceptions may not be allowed to rule R unless they can be justified beyond reasonable doubt.	1&2

	4	If exceptions may not be allowed to rule R unless they can be justified beyond reasonable doubt, then it is not the case that no severely deformed infant is a person.
Therefore	5	It is not the case that no severely deformed infant is a person.	3&4

Since premise (2) is false, Argument I is unsound. The question, however, is whether or not there are any exceptions to rule R. Are there any exceptions which can be established beyond a reasonable doubt? Robertson thinks so, but only very few:

"Those suffering from malformations... that do not affect mental capacities would not fit the class of nonpersons."
"Frequently even the most severe cases of mental retardation cannot be reliably determined until a much later period."
"The only group of defective newborns who would clearly qualify as nonpersons is anencephalics, who altogether lack a brain, or those so severely brain-damaged that it is immediately clear that a sense of self can never develop."

Argument II: The "Quality of Defective Infant's Life" Argument.

	1	Every person whose continued living is in his or her own best interests has a right to ordinary but necessary medical care.
	2	No severely deformed infant is a person whose continued living is in its own best interests.
Therefore	3	No severely deformed infant has a right to ordinary but necessary medical care.	1&2

Robertson's Criticisms:

Clearly premise (2) is false: there are many severely deformed infants whose continued living is in their own best interests.
And even if there are some cases, there are very few such cases.
Of course, the infant can't indicate its preference, so we have the added difficulty of relying on a proxy's judgement.

Argument III: The "Suffering of Other's" Argument.

	1	x has a right to ordinary but necessary medical care iff the medical care of x maximizes utility.
	2	It is not the case that the medical care of severely deformed infants maximizes utility.
Therefore	3	It is not the case that severely deformed infants have a right to ordinary but necessary medical care.	1&2

Robertson's Criticisms:

A problem with premise (1) is that it is a straightforward utilitarian principle. But how do we actually measure utility? What about the rights argument?
Also, it is clear that steps can be taken to minimize disutility:

Counselling can reduce disutility to the family.
Management can reduce disutility to health professionals.
Trade-offs in the health budget would be small if properly handled.

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