[Paleopsych] NYT Mag: Euthanasia for Babies?

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Euthanasia for Babies?
New York Times Magazine, 5.7.10
http://www.nytimes.com/2005/07/10/magazine/10WWLN.html

[I am enthusiastic about euthanasia myself and would not only place very few 
restrictions on it, but encourage the ending of lives without pleasure, 
engagement, or meaning (the three ingredients of happiness). Not that I'm eager 
to euthanise anyone myself. I would be reluctant to defy deeply-held attitudes, 
many of which I've internalized. It's that I'd prefer to live in a society 
where these attitudes have changed so as to be more supportive of euthanasia. 
Please understand this distinction.]

    By JIM HOLT

    One sure way to start a lively argument at a dinner party is to raise
    the question Are we humans getting more decent over time? Optimists
    about moral progress will point out that the last few centuries have
    seen, in the West at least, such welcome developments as the abolition
    of slavery and of legal segregation, the expansion of freedoms (of
    religion, speech and press), better treatment of women and a gradual
    reduction of violence, notably murder, in everyday life. Pessimists
    will respond by citing the epic evils of the 20th century -- the
    Holocaust, the Gulag. Depending on their religious convictions, some
    may call attention to the breakdown of the family and a supposed
    decline in sexual morality. Others will complain of backsliding in
    areas where moral progress had seemingly been secured, like the
    killing of civilians in war, the reintroduction of the death penalty
    or the use of torture. And it is quite possible, if your dinner guests
    are especially well informed, that someone will bring up infanticide.

    Infanticide -- the deliberate killing of newborns with the consent of
    the parents and the community -- has been common throughout most of
    human history. In some societies, like the Eskimos, the Kung in Africa
    and 18th-century Japan, it served as a form of birth control when food
    supplies were limited. In others, like the Greek city-states and
    ancient Rome, it was a way of getting rid of deformed babies. (Plato
    was an ardent advocate of infanticide for eugenic purposes.) But the
    three great monotheistic religions, Judaism, Christianity and Islam,
    all condemned infanticide as murder, holding that only God has the
    right to take innocent human life. Consequently, the practice has long
    been outlawed in every Western nation.

    This year, however, a new chapter may have begun in the history of
    infanticide. Two physicians practicing in the Netherlands, the very
    heart of civilized Europe, this spring published in The New England
    Journal of Medicine a set of guidelines for what they called infant
    ''euthanasia.'' The authors named their guidelines the Groningen
    protocol, after the city where they work. One of the physicians, Dr.
    Eduard Verhagen, has admitted to presiding over the killing of four
    babies in the last three years, by means of a lethal intravenous drip
    of morphine and midazolam (a sleeping agent). While Verhagen's actions
    were illegal under Dutch law, he hasn't been prosecuted for them; and
    if his guidelines were to be accepted, they could establish a legal
    basis for his death-administering work.

    At first blush, a call for open infanticide would seem to be the
    opposite of moral progress. It offends against the ''sanctity of
    life,'' a doctrine that has come to suffuse moral consciousness,
    especially in the United States. All human life is held to be of equal
    and inestimable value. A newborn baby, no matter how deformed or
    retarded, has a right to life -- a right that trumps all other moral
    considerations. Violating that right is always and everywhere murder.

    The sanctity-of-life doctrine has an impressively absolute ring to it.
    In practice, however, it has proved quite flexible. Take the case of a
    baby who is born missing most or all of its brain. This condition,
    known as anencephaly, occurs in about 1 in every 2,000 births. An
    anencephalic baby, while biologically human, will never develop a
    rudimentary consciousness, let alone an ability to relate to others or
    a sense of the future. Yet according to the sanctity-of-life doctrine,
    those deficiencies do not affect its moral status and hence its right
    to life. Anencephalic babies could be kept alive for years, given the
    necessary life support. Yet treatment is typically withheld from them
    on the grounds that it amounts to ''extraordinary means'' -- even
    though a baby with a normal brain in need of similar treatment would
    not be so deprived. Thus they are allowed to die.

    Are there any limits to such ''passive'' euthanasia? A famous test
    case occurred in 1982 in Indiana, when an infant known as Baby Doe was
    born with Down syndrome. Children with Down syndrome typically suffer
    some retardation and other difficulties; while presenting a great
    challenge to their parents and families, they often live joyful and
    relatively independent lives. As it happened, Baby Doe also had an
    improperly formed esophagus, which meant that food put into his mouth
    could not reach his stomach. Surgery might have remedied this problem,
    but his parents and physician decided against it, opting for
    painkillers instead. Within a few days, Baby Doe starved to death. The
    Reagan administration responded to the case by drafting the ''Baby Doe
    guidelines,'' which mandated life-sustaining care for such handicapped
    newborns. But the guidelines were opposed by the American Medical
    Association and were eventually struck down by the Supreme Court.

    The distinction between killing a baby and letting it die may be
    convenient. But is there any moral difference? Failing to save
    someone's life out of ignorance or laziness or cowardice is one thing.
    But when available lifesaving treatment is deliberately withheld from
    a baby, the intention is to cause that baby's death. And the result is
    just as sure -- if possibly more protracted and painful -- as it would
    have been through lethal injection.

    It is interesting to contrast the sort of passive euthanasia of
    infants that is deemed acceptable in our sanctity-of-life culture with
    the active form that has been advocated in the Netherlands. The
    Groningen protocol is concerned with an element not present in the
    above cases: unbearable and unrelievable suffering. Consider the case
    of Sanne, a Dutch baby girl who was born with a severe form of
    Hallopeau-Siemens syndrome, a rare skin disease. As reported earlier
    this year by Gregory Crouch in The Times, the baby Sanne's ''skin
    would literally come off if anyone touched her, leaving painful scar
    tissue in its place.'' With this condition, she was expected to live
    at most 9 or 10 years before dying of skin cancer. Her parents asked
    that an end be put to her ordeal, but hospital officials, fearing
    criminal prosecution, refused. After six months of agony, Sanne
    finally died of pneumonia.

    In a case like Sanne's, a new moral duty would seem to be germane: the
    duty to prevent suffering, especially futile suffering. That is what
    the Groningen protocol seeks to recognize. If the newborn's prognosis
    is hopeless and the pain both severe and unrelievable, it observes,
    the parents and physicians ''may concur that death would be more
    humane than continued life.'' The protocol aims to safeguard against
    ''unjustified'' euthanasia by offering a checklist of requirements,
    including informed consent of both parents, certain diagnosis,
    confirmation by at least one independent doctor and so on.

    The debate over infant euthanasia is usually framed as a collision
    between two values: sanctity of life and quality of life. Judgments
    about the latter, of course, are notoriously subjective and can lead
    you down a slippery slope. But shifting the emphasis to suffering
    changes the terms of the debate. To keep alive an infant whose short
    life expectancy will be dominated by pain -- pain that it can neither
    bear nor comprehend -- is, it might be argued, to do that infant a
    continuous injury.

    Our sense of what constitutes moral progress is a matter partly of
    reason and partly of sentiment. On the reason side, the Groningen
    protocol may seem progressive because it refuses to countenance the
    prolonging of an infant's suffering merely to satisfy a dubious
    distinction between ''killing'' and ''letting nature take its
    course.'' It insists on unflinching honesty about a practice that is
    often shrouded in casuistry in the United States. Moral sentiments,
    though, have an inertia that sometimes resists the force of moral
    reasons. Just quote Verhagen's description of the medically induced
    infant deaths over which he has presided -- ''it's beautiful in a way.
    . . . It is after they die that you see them relaxed for the first
    time'' -- and even the most spirited dinner-table debate over moral
    progress will, for a moment, fall silent.

    Jim Holt is a frequent contributor to the magazine.