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Comments and Recommendations on the “Infant Doe” Proposed Regulations

Published online by Cambridge University Press:  27 April 2021

Committee on the Legal and Ethical Aspects of Health Care for Children
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Extract

The decision whether or not to treat a newborn infant with a major birth defect or other life-threatening condition presents a multitude of medical, ethical and legal problems for all individuals involved. This is particularly true when the child’s prognosis, even with therapy, is uncertain or when treatment may result in or prolong a life fraught with substantial suffering. The proper roles of the physician and other hospital personnel, and especially of the child‘s parents, have yet to be fully or adequately resolved. Nonetheless, recent public awareness of isolated cases has made it clear that the status quo is not acceptable. The Committee on the Legal and Ethical Aspects of Health Care for Children (Children’s Committee) believes that hospitals and state agencies must do more to protect seriously ill newborns and to provide greater support—medical, psychological, and financial—to those in need.

Type
Article
Information
Law, Medicine and Healthcare , Volume 11 , Issue 5 , October 1983 , pp. 203 - 213
Copyright
Copyright © American Society of Law, Medicine and Ethics 1983

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References

In the interest of timely submission, these Comments and Recommendations have not been reviewed by the general membership of the American Society of Law & Medicine.Google Scholar
48 Fed. Reg. 30846-30852 (July 5, 1983).Google Scholar
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (U.S. Government Printing Office, Washington, D.C.) (March 1983) [hereinafter cited as Deciding to Forego Treatment].Google Scholar
See, e.g., Guidelines for Discontinuance of Cardiopulmonary Life-Support Systems Under Specified Circumstances, Los Angeles, in Legal and Ethical Aspects of Treating Critically and Terminally Ill Patients (Doudera, A.E. Peters, J.D., eds.) (AUPHA Press, Ann Arbor, Mich.) (1982) at 291-93; Supportive Care Plan (report and recommendations of a multidisciplinary task force convened by the Minnesota Board of Aging) (1983) (copies available through ASLM, 765 Commonwealth Ave., Boston, MA 02215).Google Scholar
Deciding to Forego Treatment, supra note 3, at 214.Google Scholar
Id. at 227.Google Scholar
The American Academy of Pediatrics Comments on the “Baby Doe II”Regulations, New England Journal of Medicine 309 (7): 443, 44 (August 18, 1983) (hereinafter referred to as Pediatrics Comments).Google Scholar
Report of the Surgeon General's Workshop on Children with Handicaps and Their Families (U.S. Department of Health and Human Services, Washington, D.C.) (1982) at 6.Google Scholar
American Academy of Pediatrics v. Heckler, 561 F. Supp 395, 399 (D.D.C. 1983).Google Scholar
Baby Doe Rule's Successes Told, American Medical News, August 19, 1983, at 1, 6.Google Scholar
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A recent Gallup poll indicates that the public is evenly divided on whether or not a seriously handicapped or deformed newborn should be allowed to die. Asked what they would do as parents of a “badly deformed baby who would live only a few years,”40 percent said they would ask doctors to keep the baby alive while 43 percent said they would terminate treatment; 17 percent had no opinion. In another study conducted by the American Hospital Association and released in March 1983, 67 percent of those asked felt that patients’ families should decide if the patient should be kept alive, while only 14 percent thought the physician should decide. See also American Academy of Pediatrics, Statement on the Treatment of Critically Ill Newborns, Pediatrics (forthcoming, October 1983) (“It is impossible at this time to identify a consensus on which infants or children…should be treated.”)Google Scholar
The Children's Committee supports and concurs with the need for and appropriateness of an interdisciplinary membership for such a committee, and supports the following policy statement of the American Nurses Association: “[Nurses are encouraged] to be involved with physicians and others who make decisions about life and death situations, including those of handicapped infants.”Google Scholar
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In April 1983, the American Society of Law & Medicine sponsored a national conference on the role and functions of institutional ethics committees at which experts discussed the potential for and the practical problems of such committees. Although most speakers perceived the value of institutional ethics committees, there was no clear consensus on the appropriate procedures, tasks, or composition of such committees. The Society is presently preparing the proceedings of this conference for publication this fall.Google Scholar
American Academy of Pediatrics v. Heckler, supra note 9, at 401-02.Google Scholar
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Childress, J.F., Triage in Intensive Care: The Limitation of a Metaphor, Virginia Law Review 69: 547, 557 (1983).Google Scholar
Pediatrics Comments, supra note 7, at 444.Google Scholar
Id. at 443.Google Scholar