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SOC 573 - Infant Euthanasia

SOC 573 - Infant Euthanasia. James G. Anderson, Ph.D. Medical Advances. In 1984 25% of extremely low birth weight babies survived at least two years. By 1994 50% of extremely low birth weight babies survived at least two years.

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SOC 573 - Infant Euthanasia

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  1. SOC 573 - Infant Euthanasia James G. Anderson, Ph.D.

  2. Medical Advances • In 1984 25% of extremely low birth weight babies survived at least two years. • By 1994 50% of extremely low birth weight babies survived at least two years. • Through aggressive measures, babies with a birth weight of 1000 grams (2 pounds 3 ounces) have a good chance of surviving. • Today babies weighing as little as 600 grams (1.3 pounds) may survive.

  3. Curbs on Rights of Parents to Decide • Right-to-Life Groups • Advocates for the disabled • Federal law that states that it is neglect to withhold life-sustaining care unless treatment appears altogether futile or the child is permanently unconscious.

  4. Other Factors • Insurers and hospitals rarely balk at high cost of care. • Courts are reluctant to order a halt to treatment if a parent or physician wants to continue care.

  5. Other Factors • Courts have ruled that doctors must base treatment decisions on an assessment of the child’s best interest, but it is not clear whose opinion must prevail. • Neonatalogists argue that early aggressive treatment is warranted because they don’t know how an infant will respond.

  6. Case In 1994, the U.S. Supreme Court refused to consider a case in which an appeals court had ordered continued life support for a Virginia girl born without most of her brain. Her mother fought the hospital’s efforts to terminate life support. The appeals court ruled that treatment was required even though the doctors considered it ‘medically and ethically inappropriate.”

  7. Case In Cicero, IL , house painter, Rudy Linares, removed life support from his 15-month-old son while holding off hospital staff with a gun. A grand jury refused to indict him on murder charges and the state dropped the case.

  8. Case About an hour after the premature birth of their third child, Greg and Traci Messenger, shut the door to the room and removed their 1 pound 11 ounce boy from the life support system. The sound of the automatic alarm brought a doctor and nurse running to the room , but too late. Cut off from its oxygen supply, the infant died. His father, a dermatologist, now faces prosecution for manslaughter.

  9. Types of Cases • Babies born with a genetic defect, Down’s Syndrome, which causes mental retardation. Some of these babies have defects of the heart and esophagus which must be treated by surgery or the baby will die.

  10. Types of Cases • Babies born with neural tube defects where the spinal cord has not closed during fetal development (e.g., spina bifida); some cases are severe and include mental retardation; others are minor. The lesion must be closed surgically or the baby will die of infection

  11. Types of Cases • Babies born prematurely; some congenital or inborn birth defects may be present. Often the babies’ main problem is that their organs, particularly their lungs, are too immature to sustain life.

  12. Conditions for Withholding Life-Prolonging Interventions • Extended life is judged not to constitute a net benefit to the infant. • It is believed that the infant’s condition is such that the capacities sufficient for a minimal independent existence of personhood can not be obtained. • The cost to other persons, especially parents and family, are sufficient to overcome customary duties toward the infant.

  13. Survey of American Academy of Pediatrics Surgical Section • 80% did not believe that the life of each and every newborn infant should be saved if it is within the ability to do so. • 23% would ask the parents not to consent to surgery and to allow the physician to decide if an infant with Down’s Syndrome also had an intestinal obstruction.

  14. Survey of American Academy of Pediatrics Surgical Section • 50% would provide the parents with all known facts and would allow the parents to decide if an infant with Down’s Syndrome should have surgery for an intestinal obstruction. • 8% would acquiesce to the parent’s decision to refuse surgery for an infant with simple intestinal atresia.

  15. Questions • How accurate is the prediction of outcomes? • Is there an accepted level of quality of life? • Does it make a difference if treatment is not initiated or it is stopped? • Who should decide?

  16. Questions • Whose interests are the parents serving? • Who should bare the costs of the decision? • If we permit infants to die without treatment, have we started on a “slippery slope”?

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