Incremental Infanticide: Who is it good for?
By Colleen Clements

The medical profession is taking baby steps toward killing severely disabled newborns.
           
The Royal College of Obstetricians and Gynecologists in Britain is calling for taking the next step in euthanasia or “mercy killing.” That won’t be allowed to be conceptually clear, though. Instead, it will be presented as a neutral discussion looking at all the possibilities of the mercy killing of severely disabled babies. The college calls it a “deliberate intervention” to cause the death of such disabled infants, and wants to initiate simply a debate and analysis of possible legalization of such direct killing. The college was most careful to state it was not necessarily supporting such killing, but was only supporting talking about this deliberate intervention and its ethical and legal implications. This is, of course, a classic example of the deliberate incremental steps of euthanasia advocates and the techniques successfully used to enable those steps.
           
Withdrawing or withholding treatment in cases of severely disabled newborns or infants is legal in many cases, sometimes without the permission of the parents, or even against the wishes of the parents. In those cases of hospital desire to withhold or withdraw treatment, futility of treatment is the reason generally given. In cases where the parents support withholding and withdrawing treatment, the quality of life of the child is the predominant reason. This step in indirect killing was taken with the same strategy as the new step suggests. Working groups reported to medical journals, but the working groups were usually activists for the step.
           
Legal cases were fought as major index cases, with activists again supplying support and legal help. The first cases were assured to be only with the consent of surrogates, and freely decided by those surrogates only, not by the hospital system.
           
Previous steps in indirect killing of patients were used to argue that the new step had to be taken to insure equality under the law and not discriminate against certain other groups who did not yet enjoy this right.
           
With a combination of bioethics activists, media ideal cases and legal extension of existing rights, the withholding and withdrawing step was fully instituted in most Western societies, including the U.S. and Canada. Having begun with what was inaccurately characterized as a neutral discussion only, the step was quickly implemented. Incrementalism is a potent tool.
           
This call by the British College is part of a step-by-step advance which will eventually allow physicians to directly kill severely disabled babies. If it follows the pattern, we will next see an emotional argument made where great pain and suffering occurs to a helpless baby because physicians were not able to directly kill that child and end the suffering. Other cases will follow, and there will be a call to change the law, either by using a case or by statute. We will again be falsely reassured that only freely chosen killings will occur, with loving surrogates making those choices based on what is good for the child.
           
No one will talk much about the economic savings that could be realized from such direct and swift killing. “Safeguards” will be put in place to further reassure the public, although in reality no safeguards are very effective and can easily be circumvented. (I’ve seen how easily that can be done, time after time.) We will come up with new words to describe such killings, words that will make us complacent and buffer us from reality; words like “deliberate intervention” rather than “direct killing by physicians of disabled babies.”
           
But I do have to reveal my emotional mixed feelings about this bioethics issue. Life is never simple or easy. My own second pregnancy was a wished-for pregnancy, but there was an early complication. In my first three weeks, I had been exposed to rubella by my niece and nephew.
           
When I called my physician, having just learned I was pregnant, he had me come in that weekend to his office, where he had managed to get a shot of immunoglobulin for me. I arrived at his office with a beginning rash that morning. He took one look and shook his head. There was no point to the shot. I already had the disease. He was an internist, and his concern was high for the pregnancy.
           
My obstetrician, at the first meeting, was nowhere near that concerned. He felt the new research out of Australia was preliminary and likely to be wrong. He reassured me he had never had a single case of bad outcome in his practice from a rubella infection. He advised against terminating the pregnancy, and since that was compatible with my desire for a second child, I accepted his advice.
           
Unfortunately, his advice was incorrect. The pregnancy seemed to be abnormal to me, but he said nothing. On the last visit in my seventh month gestation, he did not tell me he could hear no baby’s heartbeat, nor did he tell me he was concerned about the fetus and its failure to grow. A few days after that visit, labor began unexpectedly for me, and it was at the hospital that I learned the fetus was dead in utero.
           
A macerated fetus (a girl I did not see) was delivered quickly, and an autopsy revealed Tetralogy of Fallot in a fetus that had failed to thrive.
           
It was a sad time, yet I was also relieved the fetus had died. The heart defect was only one sign of a disabled fetus. Most likely, the brain would have been damaged as well, and the consequences would not have been ones I could have borne. I would strongly have wanted that child to die, for its sake and for mine, and the future six children I would have would not have had to be unrealized because of this damaged fetus. I could have coped. But not at the beginning of life. There is something about that tragic fate that makes me want to say to physicians, “All right, directly kill the child.”
But that is irrational and wrong. I thank the fates that the fetus died in utero, without anyone having to destroy it, but I can’t agree that physicians killing babies is ethical or wise. We really need to hold the line at withdrawing or withholding treatment at the surrogate’s request, or we create an immoral society. What in summary are the arguments?
  
• The baby’s quality of life is too low to justify its continued life. Using that argument, children born in impoverished countries or families should be killed. We could just as easily make that argument. It is not always clear what constitutes sufficient quality of life, and most of us will eventually wind up in situations where others question our quality of life. Our right to exist is a fundamental right, for which we do not have to justify ourselves.
  
• We already allow such children a slow death, and a quick direct intervention would be more ethical, since there is no difference between indirect and direct killing. There is, in fact, a critical difference, even though the external outcome is the same death. Someone has to sanction the killing and someone has to do it. That extracts a dangerous price from social values and from the physician’s internal values. It is always risky ethically to kill a member of our own species, for it destroys the social bonds that make everyone’s existence possible.
  
• If we give disabled babies the benefit of indirect killing, it is their right to enjoy the benefit of direct killing. I will allow that in extreme cases, there may be a benefit to dying, though physicians lately are far too likely to side with death rather than life. But the personal and social costs of direct killing are too high, and we already have indirect killing in such extreme circumstances. Dying can be made comfortable. If it can’t, the alternative is not to withdraw or withhold, rather than to directly kill. Or at least, there are two logical and opposite alternatives to that argument, which makes it a non-argument.
 
• Medical care is more appropriately given to “normal” babies and patients, and the money should not be allocated to the disabled. I will accept that argument from the nations with the very lowest economic levels, but not from the developed world.
 
• Medicine should prevent suffering. Yes, it should, but not at the cost of physicians terminating the sufferers and allying themselves with death. There is a tendency to romanticize death or to side with the aggressor death. Physicians need to guard against that. There will be safeguards to prevent abuse, and surrogate autonomy trumps other values. No safeguards can prevent abuse. Autonomy cannot trump all other values in any other area of society except medicine and abortion, and it is a suspect trump even there.
 
Colleen Clements is adjunct clinical associate professor of psychiatry at the University of Rochester in Rochester, N.Y..  This article was first published in The Medical Post, Jan.9, 2007 and is reprinted with permission of the author.