Topic Three: Would you answer both these questions in the same way? Why, or why not?
i. Is a physician ever justified in withdrawing life-support, including a respirator, from an infant so premature that it cannot breathe on its own?
ii. Is a physician ever justified in giving a lethal injection to a severely disabled infant?
To both questions, I would answer affirmatively, that there are indeed cases where a physician would be justified in withdrawing life support from a premature infant, or in the case of a severely disabled infant, in giving a lethal injection. Of course, several conditions must be met to for this serious measure to be justifiable. The infant in question must at least be in a state meeting three conditions: the infant cannot survive without extreme and constant measures of support to sustain basic life functions, that there is no reasonable expectation of improvement of the infant and no expectation of improvement in medical science to alleviate the condition, and that continuing the life of the infant means extraordinary suffering for the infant and family.
The first case, where life support is withdrawn, is a type of passive euthanasia. The second case, where a lethal means is used to terminate life, is active euthanasia. Both situations are cases for considering non-voluntary euthanasia, that is, where euthanasia is warranted but the subject is unable to make the decision.1 Since the decision cannot be made by the infant, there should be a procedure followed that euthanasia is warranted and agreed to by parents, the physician, and be some third party such as a medical ethicist or civil authority. The cases of infants are different than those of adults not only in the necessity for outside consent, but because infants are not equal to adults the evaluation of the morality of the decision. This is best clarified by Peter Singer, who writes, that in consideration of the wrongness of killing, “characteristics like rationality, autonomy and self-consciousness that make a difference. Defective infants lack these characteristics. Killing them, therefore, cannot be equated with killing normal human beings….”2
There are secondary considerations that should be given great weight. Is the infant in a culture or in a religious hospital that forbids such a passive euthanasia? Does the prevailing law of the locale or the protocols of the hospital allow or prohibit such action? Will there be such enormous expense to continuing life support that may make the prolonged life unsustainable be the economy or the caregiver’s ability to sustain treatment? Will the prolongation of life cause unbearable suffering on the part of the parents or caregivers, or, would the termination of life-support of the child cause unbearable mental anguish on the part of the parents?
Some might raise an objection claiming that all life, or all human life is sacred and must be maintained at all cost. This position is extreme. The life of some humans or potential humans is so diminished or defective or unbearable that it’s ending is not equal to the end of a fully adult, conscious, aware and pain-free life.
Giving a lethal injection to a severely defective infant can be justified, but requires some additional considerations. Resorting to an active intervention to terminate life where the infant could survive with simple medical interventions could raise at least two objections. The intention would be to kill, and traditional thinking about killing is that this act is inherently evil so that the permissibility test for the doctrine of double effect cannot me met.3 Additionally, there is a common sense and psychological aversion to actively killing an infant. However, there can be two strong responses to these objections. The severely defective infant is not a full human person in that there is no expectation of the development of rationality or a sense of self and the medical situation prevents any expectation of the development of autonomy. Additionally, the result of either the passive or active intervention is death, so there is no difference at all in the most important thing to consider. Furthermore, there is no “potential” humanity or “potential rights”, a value that ranks high for many.4
Some might argue that the parent’s or caregiver’s burden is not a secondary consideration at all, but is the most important and deciding factor. The situation of an extremely defective infant sustained only by extreme means is not significantly different than a fetus. Think about a position somewhat similar or analogous to that of Judith Jarvis Thompson, that no one has the right to use another person to sustain whatever life is available. This would mean the parent’s rights to a full life unburdened by extreme emotional toll and financial burden of care of the infant. However, if this is the primary concern, then we are giving little weight to the value of the admittedly defective infant or the serious moral implication of life or death considerations. What is more, there is the danger of self-serving parents or medical caregivers who may be seeking relief of the burden of an infant whose condition does not warrant passive or active euthanasia.
1 definitions from Robert Young, “Voluntary Euthanasia,” The Stanford Encyclopedia of Philosophy (Fall 2010 Edition), Edward N. Zalta (ed.),http://plato.stanford.edu/archives/fall2010/entries/euthanasia-voluntary
2 Peter Singer, Practical Ethics, Cambridge, Cambridge University Press, 1979 ed., page 131.
3 Alison McIntyre, ”Doctrine of Double Effect,” The Stanford Encyclopedia of Philosophy, Edward N. Zalta (ed.).http://plato.stanford.edu/entries/double-effect/
4 “Potential Human, Potential Rights,” http://www.bbc.co.uk/ethics/abortion/child/potential.shtml, accessed 7Apr2014
Two Strikes 