Why Evolution Is True

Should one be allowed to euthanize severely deformed or doomed newborns?

The question of whether one should be able to euthanize newborns who have horrible conditions or deformities, or are doomed to a life that cannot by any reasonable light afford happiness, has sparked heated debate.  Philosopher Peter Singer has argued that euthanasia is the merciful action in such cases, and I agree with him. If you are allowed to abort a fetus that has a severe genetic defect, microcephaly, spina bifida, or so on, then why aren’t you able to euthanize that same fetus just after it’s born?  I see no substantive difference that would make the former act moral and the latter immoral. After all, newborn babies aren’t aware of death, aren’t nearly as sentient as an older child or adult, and have no rational faculties to make judgments (and if there’s severe mental disability, would never develop such faculties). It makes little sense to keep alive a suffering child who is doomed to die or suffer life in a vegetative or horribly painful state. After all, doctors and parents face no legal penalty for simply withdrawing care from such newborns, like turning off a respirator, but Singer suggests that we should be allowed, with the parents’ and doctors’ consent, to painlessly end their life with an injection. I agree.

This is one area in which philosophy has a big contribution to make (and science can play an ancillary role, telling us the likelihood that a child will survive such conditions). Peter Singer’s utilitarian views on the issue can be seen in a 2005 op-ed at the Los Angeles Times, “Pulling back the curtain on the mercy killing of newborns“.  This is apparently already allowed in the Netherlands. As Singer wrote:

In Thursday’s New England Journal of Medicine, two doctors from the University Medical Center Groningen in the Netherlands outline the circumstances in which doctors in their hospital have, in 22 cases over seven years, carried out euthanasia on newborn infants. All of these cases were reported to a district attorney’s office in the Netherlands. None of the doctors were prosecuted.

Eduard Verhagen and Pieter Sauer divide into three groups the newborns for whom decisions about ending life might be made.

The first consists of infants who would die soon after birth even if all existing medical resources were employed to prolong their lives.

In the second group are infants who require intensive care, such as a respirator, to keep them alive, and for whom the expectations regarding their future are “very grim.” These are infants with severe brain damage. If they can survive beyond intensive care, they will still have a very poor quality of life.

The third group includes infants with a “hopeless prognosis” and who also are victims of “unbearable suffering.” For example, in the third group was “a child with the most serious form of spina bifida,” the failure of the spinal cord to form and close properly. Yet infants in group three may no longer be dependent on intensive care.

It is this third group that creates the controversy because their lives cannot be ended simply by withdrawing intensive care. Instead, at the University Medical Center Groningen, if suffering cannot be relieved and no improvement can be expected, the physicians will discuss with the parents whether this is a case in which death “would be more humane than continued life.” If the parents agree that this is the case, and the team of physicians also agrees — as well as an independent physician not otherwise associated with the patient — the infant’s life may be ended.

. . . One thing is undisputed: Infants with severe problems are allowed to die in the U.S. These are infants in the first two of the three groups identified by Verhagen and Sauer. Some of them — those in the second group — can live for many years if intensive care is continued. Nevertheless, U.S. doctors, usually in consultation with parents, make decisions to withdraw intensive care. This happens openly, in Catholic as well as non-Catholic hospitals.

. . .I believe the Groningen protocol to be based on the sound ethical perception that the means by which death occurs is less significant, ethically, than the decision that it is better that an infant’s life should end. If it is sometimes acceptable to end the lives of infants in group two — and virtually no one denies this — then it is also sometimes acceptable to end the lives of infants in group three.

For these views Singer has been demonized by disability rights advocates, who have called for his firing and disrupted his talks (see my post about that here). All for just raising a reasonable ethical question that should be considered and discussed! After all, fifty years ago the same kind of opprobrium would have been leveled at those calling for voluntary euthanasia (assisted suicide) of terminally ill adults, but now that’s legal in several places in the world; as Wikipedia notes, “As of June 2016, human euthanasia is legal in the Netherlands, Belgium, Colombia, and Luxembourg. Assisted suicide is legal in Switzerland, Germany, Japan, Canada, and in the US states of Washington, Oregon, Colorado, Vermont, Montana, Washington DC, and California.”  (I’ve heard from several doctors that humane euthanasia of adults is in fact practiced in the US: doctors will give patients an overdose of morphine to ease their suffering, knowing it will kill them.)

This change in views about euthanasia and assisted suicide are the result of a tide of increasing morality in our world, a tide described and explained by Steve Pinker in his superb book The Better Angels of Our Nature (yes, it’s long, but you really must read it!). It’s time to add to the discussion the euthanasia of newborns, who have no ability or faculties to decide whether to end their lives. Although discussing the topic seems verboten now, I believe some day the practice will be widespread, and it will be for the better. After all, we euthanize our dogs and cats when to prolong their lives would be torture, so why not extend that to humans? Dogs and cats, like newborns, can’t make such a decision, and so their caregivers take the responsibility. (I have done this myself to a pet, as have many of you, and firmly believe it’s the right thing to do. Our pain at making such a decision is lessened knowing that dogs and cats, like newborns, don’t know about death and thus don’t fear it.)

The reason we don’t allow euthanasia of newborns is because humans are seen as special, and I think this comes from religion—in particular, the view that humans, unlike animals, are endowed with a soul. It’s the same mindset that, in many places, won’t allow abortion of fetuses that have severe deformities. When religion vanishes, as it will, so will much of the opposition to both adult and newborn euthanasia.

My view, then, aligns with Singer’s: a child falling in any of the classes above should be considered as a subject for euthanasia, and it should be legal if the doctors and parents concur. As for the “slippery slope” argument—that this will lead to Nazi-like eugenics—well, this hasn’t come to pass in places where assisted suicide or euthanasia of adults is legal. Since the newborn can’t decide, it’s up to the parents, with advice (and maybe consent) of the doctors.

The pain of these newborns, and of making these decisions, is evident in a piece in yesterday’s New York Times’ “The Stone” section (a philosophy column), provocatively called “You should not have let your baby die.” (What the author means is that “you should have killed your baby.”) It describes the situation of parents whose baby was born with “trisomy 18”: three rather than the normal two copies of chromosome 18. Trisomy 21, three copies of the smaller 21st chromosome, is what produces Down Syndrome. But unlike the Down case, trisomy 18, involving imbalance of a larger chromosome, produces a severe condition, with most children dying horrible deaths soon after birth. A few, though, can live into their 20s and 30s.

Therein lies the dilemma. Should you take that chance? The child described by author Gary Comstock, a philosophy professor at North Carolina State University, was in dire shape, forced to breathe on a respirator and unable to survive without one. The odds that that child could live in a decent state were nil. After agonizing over what to do, the parents decided to take the legal course of withdrawing care: removing the respirator. The child slowly suffocates. I want to put up the end of the column, as it shows the case for euthanasia of a newborn like this:

The nurse comes in, mute. You look at him, sleeping. He seems at peace. You nod your head. She gently pulls the tube. It slides out quickly, as though he were helping to expel it. Without his lifeline, he does not move. A minute later, his eyes open. It is the first time you have seen them. His head jerks slightly forward. He does not cry. He gasps silently for breath. His eyes close. You almost yell for the nurse, to beg her to put it back in. To keep from doing so, you pray, arguing with God that letting him die is best for him. After five minutes, his face pales, then turns a sickly purple. His tiny chest convulses irregularly in an unsuccessful attempt to draw air into the lungs. After 20 minutes, he lies still. His fingers turn gray.

Thirty minutes. There are no visible signs of life. You rock his limp body as tears fall on the blue blanket. You wonder what sort of beast you are. Forty-five minutes. Grandma looks in, ashen faced, seeing in a glance that it is over. Shortly your wife appears. She immediately takes her son’s body in her arms and coddles him. She sits there with him for three hours.

You should not have let your baby die. You should have killed him.

This thought occurs to you years later, thinking about the gruesome struggle of his last 20 minutes. You are not sure whether it makes sense to talk about his life, because he never seemed to have the things that make a life: thoughts, wants, desires, interests, memories, a future. But supposing that he had thoughts, his strongest thought during those last minutes certainly appeared to be: “This hurts. Can’t someone help it stop?” He didn’t know your name, but if he had, he would have said: “Daddy? Please. Now.”

It seems the medical community has few options to offer parents of newborns likely to die. We can leave our babies on respirators and hope for the best. Or remove the hose and watch the child die a tortured death. Shouldn’t we have another choice? Shouldn’t we be allowed the swift humane option afforded the owners of dogs, a lethal dose of a painkiller?

For years you repress the thought. Then, early one morning, remembering again those last minutes, you realize that the repugnant has become reasonable. The unthinkable has become the right, the good. Painlessly. Quickly. With the assistance of a trained physician.

You should have killed your baby.