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it was in the best interests of Baby Doe, and of their family as
a whole (they had two other children), to refuse consent for
the operation. The hospital authorities, uncertain of their legal
position, took the matter to court. Both the local county court
and the Indiana State Supreme Court upheld the parents' right
to refuse consent to surgery. The case attracted national media
attention, and an attempt was made to take it to the U.S. Supreme
Court, but before this could happen, Baby Doe died.
One result ofthe Baby Doe case was that the U.S. government,
headed at the time by President Ronald Reagan, who had come
to power with the backing of the right-wing religious 'Moral
Majority', issued a regulation directing that all infants are to be
given necessary life-saving treatment, irrespective of disability.
But the new regulations were strongly resisted by the American
Medical Association and the American Academy of Pediatrics.
In court hearings on the regulations, even Dr C. Everett Koop,
Reagan's surgeon-general and the driving force behind the attempt
to ensure that all infants should be treated, had to admit
that there were some cases in which he would not provide lifesustaining
treatment. Dr Koop mentioned three conditions in
which, he said, life-sustaining treatment was not appropriate:
anencephalic infants (infants born without a brain); infants who
had, usually as a result of extreme prematurity, suffered such
severe bleeding in the brain that they would never be able to
breathe without a respirator and would never be able even to
recognise another person; and infants lacking a major part of
their digestive tract, who could only be kept alive by means of
a drip providing nourishment directly into the bloodstream.
The regulations were eventually accepted only in a watereddown
form, allowing some flexibility to doctors. Even so, a
subsequent survey of American paediatricians specialising in the
care of newborn infants showed that 76 percent thought that
the regulations were not necessary, 66 percent considered the
204
Taking Life: Humans
regulations interfered with parents' right to determine what
course of action was in the best interests of their children, and
60 percent believed that the regulations did not allow adequate
consideration of infants' suffering.
In a series of British cases, the courts have accepted the view
that the quality of a child's life is a relevant consideration in
deciding whether life-sustaining treatment should be provided.
In a case called In re B, concerning a baby like Baby Doe, with
Down's syndrome and an intestinal obstruction, the court said
that surgery should be carried out, because the infant's life
would not be 'demonstrably awful'. In another case, Re C, where
the baby had a poorly formed brain combined with severe physical
handicaps, the court authorised the paediatric team to refrain
from giving life-prolonging treatment. This was also the
course taken in the case of Re Baby J: this infant was born
extremely prematurely, and was blind and deaf and would probably
never have been able to speak.
Thus, though many would disagree with Baby Doe's parents
about allowing a Down's syndrome infant to die (because people
with Down's syndrome can live enjoyable lives and be warm
and loving individuals), virtually everyone recognises that in
more severe conditions, allowing an infant to die is the only
humane and ethically acceptable course to take. The question
is: if it is right to allow infants to die, why is it wrong to kill
them?
This question has not escaped the notice of the doctors involved.
Frequently they answer it by a pious reference to the
nineteenth-century poet, Arthur Clough, who wrote:
Thou shalt not kill; but need'st not strive
Officiously to keep alive.
Unfortunately for those who appeal to Clough's immortal
lines as an authoritative ethical pronouncement, they come
from a biting satire - 'The Latest Decalogue' - the intent of
205
Practical Ethics
which is to mock the attitudes described. The opening lines, for
example, are:
Thou shalt have one god only; who
Would be at the expense of two.
No graven images may be
Worshipped except the currency.
So Clough cannot be numbered on the side of those who
think it wrong to kill, but right not to try too hard to keep alive.
Is there, nonetheless, something to be said for this idea? The
view that there is something to be said for it is often termed
'the acts and omissions doctrine'. It holds that there is an important
moral distinction between performing an act that has
certain consequences - say, the death of a disabled child - and
omitting to do something that has the same consequences. If
this doctrine is correct, the doctor who gives the child a lethal
injection does wrong; the doctor who omits to give the child
antibiotics, knowing full well that without antibiotics the child
will die, does not.
What grounds are there for accepting the acts and omissions
doctrine? Few champion the doctrine for its own sake, as an
important ethical first principle. It is, rather, an implication of
one view of ethics, of a view that holds that as long as we do
not violate specified moral rules that place determinate moral
obligations upon us, we do all that morality demands of us.
These rules are of the kind made familiar by the Ten Commandments
and similar moral codes: Do not kill, Do not lie,
Do not steal, and so on. Characteristically they are formulated
in the negative, so that to obey them it is necessary only to
abstain from the actions they prohibit. Hence obedience can be
demanded of every member of the community.