Thursday, November 16, 2006

Extreme Preemies -- Who decides?

Art Caplan does a provocative article on MSNBC online about how the recommendations in the UK to let extreme preemmies die go to far -- but that the US has also gone too far in the past, in the opposite direction:

Is it right to let extreme preemies die?
British council recommendation goes too far — but so does U.S. law
By Arthur Caplan, Ph.D.
MSNBC contributor
Updated: 7:31 p.m. ET Nov 15, 2006

Can you name the only group in the United States that is required by law to accept medical treatment? It is newborn babies.

In 1985 Congress amended the laws governing support for child abuse and neglect programs to mandate that all infants born in the United States receive medical care. No matter how sick or disabled, all newborns, according to what became known as the Baby Doe law, must be treated. That is what makes the just-issued report by the Nuffield Council on Bioethics in England so startling.

The council, a private organization whose reports are very influential in Britain, argues premature babies born before 22 weeks gestation should not be given treatment to prolong their lives. The council was not arguing for any form of active killing. Its view is that since only 1 percent of infants born between 22 and 23 weeks of age survive long enough to leave the hospital, starting aggressive treatment on babies born at 22 weeks or younger is wrong.

The report is already drawing support from many pediatricians and neonatologists. It also drew the support of religious leaders including the Church of England (Anglican) House of Bishops and the Catholic Bishops’ Conference of England and Wales. (rest of the article here)

The case Art is referring to is Bowen v American Hospital Association, 106 S Ct 2101 (1986) -- In a 5-3 decision, the U.S. Supreme Court struck down Reagan Administration regulations (based upon the 1973 Rehabilitation Act and known as the Baby Doe Regulations) which were intended to prevent discriminatory non-treatment of handicapped newborn infants.
A difficult case, the Bowen Court viewed these rules as unnecessary to protect the rights of disabled infants and as interfering with parental rights to consent or refuse treatment based on what they deemed to be in their infants’ best interest.The Court relied heavily upon the right of parents to refuse treatment for their children. (Stevens, Powell, Marshall, Blackmun, Burger for plurality with White, O’Connor, Brennan dissenting.)

Although the law was struck down as unconstitutional, the enactment of the laws had a powerful effect on the public and how newborns are treated -- and since then Congress has enacted and re-enacted them -- Art pointed to an article by Loretta Kopelman entitled: Are the 21-Year-Old Baby Doe Rules Misunderstood or Mistaken?

[Thanks, Art]

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