Wednesday, December 28, 2011

Infanticide of disabled newborns: Issues and options

Back in 1991, J.P. Moreland wrote an article in the Criswell Theological Review titled "Infanticide: Issues and Options," which can be read online here. Moreland is a prolific author (his many books include The Recalcitrant Imago Dei: Human Persons and the Failure of Naturalism and Body & Soul: Human Nature and the Crisis in Ethics) and is currently Distinguished Professor of Philosophy at Talbot School of Theology.

From Moreland's article:
Infanticide is not new; various cultures throughout history such as China, Greece, and India have permitted it. Historically, a number of reasons have been offered to justify infanticide: 1) the absolute authority of the father over his family, 2) an abnormal child facing little prospect for a happy life, 3) an unwanted female child, 4) economic considerations, 5) social pressures (e.g., the child was conceived and born out of wedlock) and 6) a child not judged fully human (e.g., seen as a subhuman parasite).

While infanticide has been considered morally permissible in various cultures down through history, it still could not be practiced without justification, and there was a general respect for the human life of infants. This is especially true in cultures which were affected by the Judeo-Christian faith. The first century Jewish philosopher Philo was an opponent of infanticide, and the coming of Christianity, with its emphasis on the inherent value of all human beings since they are made in the image of God, moderated much of the infanticide in the cultures it penetrated.

Today, most of the moral dilemmas regarding the treatment of defective newborns occur in the neonatal intensive care units (NICUs) of hospitals. Increased medical technology has heightened our ability to sustain life and increased the need to sharpen our moral focus regarding the withholding or withdrawing of medical treatment from newborns. ...

Two main issues are involved in the debate about infanticide. First, is it morally permissible to allow a defective newborn to die, and under what conditions is this permissible? Second, if it is morally permissible to permit a defective newborn to die, then is it also morally permissible actively to take the life of that newborn? ...

This article will focus on the first question. Is it morally permissible to permit a defective newborn to die, and if so, what conditions make such an act morally permissible? There are five major views which present different answers to this question. In what follows, each view will be presented followed by an evaluation of its strengths and weaknesses.
The five views regarding the treatment of disabled newborns are these: (A) withhold treatment in light of third-party harms, (B) withhold treatment in light of quality-of-life judgments, (C) withhold treatment judged not in the child's best interests, (D) withhold treatment for defective nonpersons (i.e., newborns are not "persons" and so they do not have a right to life), and (E) treat all nondying infants.

As Moreland shows in his critiques, the first four views suffer from tremendous difficulties and ought to be euthanized. Only the fifth, what Moreland calls the "sanctity-of-life view" (i.e., the pro-life view), withstands serious scrutiny. This position "holds that all infants have equal intrinsic worth and dignity simply because they are human beings, that if it would be wrong to withhold a treatment from a nondefective infant then it is wrong to withhold it from a defective infant, and the only cases where foregoing treatment is justifiable are those where [withholding treatment] in general would be justifiable."

Moreland further explains:
[C]hildren should not be judged as to whether they are defective or not; rather, treatments should be judged as to whether or not they are effective and beneficial. If [withholding treatment] were justifiable in general, then it would be justifiable for a defective newborn: if an infant is terminal or death is imminent; if treatment is judged excessively burdensome, heroic, and extraordinary; and if death is not directly caused or intended, it can be permissible to allow an infant to die. [In such cases we do not kill, but rather allow someone to die a natural death while respecting his or her human dignity.] However, we should not ground nontreatment decisions on the basis of a handicapped condition by itself. That would be discrimination of the worst sort.
The pro-life view, notes Moreland, "preserves our intuition that all human beings have equal and intrinsic worth and dignity by grounding that intuition in membership in the natural kind, humankind"; "avoids the counterexamples, vagueness, and subjectivity inherent in the quality-of-life and the nonperson views"; "places the proper focus of infanticide on the infant alone while preserving the principle of justice which requires that we not discriminate against the weak and helpless"; "accords with the basic conviction that it is simply wrong to kill infants"; and "preserves the respect for life in the family, medicine, and society at large."

Let me briefly mention the second question Moreland posed, which he does not address in his article: whether it is permissible to actively kill a disabled newborn. Given the impermissibility of causing the death of newborn babies by withholding care/treatment on the grounds of disability (explained above), it is clear that actively causing death (such as with a lethal injection) is also impermissible. This second practice, though obviously wrong, is actually advocated for by a number of thinkers, and is disturbingly and openly used in the Netherlands.

Both practices -- killing disabled infants both passively and actively -- are a form of infanticide that is sometimes called child euthanasia. And both are grave moral wrongs in light of the equal dignity and fundamental rights of every member of the human family, regardless of health, disability or "defect."

I recommend reading Moreland's helpful ethical analysis of this crucial life-or-death issue in our culture.