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Violence in the Hospital?

Gordon Slater, Editor, "Newspeace" published by the Fellowship of Reconciliation
December 1981
© Gordon Slater
  Reprinted with the permission of Catherine Slater

The case of Dr Arthur and the baby with Down's syndrome raises a number of very difficult quest ions, which the case Itself has not helped to answer. At its broadest level the issue resolve itself into whether one person, or group of people, however well intentioned, has the moral right to make decisions affecting the life or death of another. At another and more practical, it seems to me urgently necessary to change a state of affairs where a baby's chance of survival depends on its choosing the right parents and the right hospital to be born in.

My own experience may be relevant, though I recognise that one of the difficulties in this area is precisely the great variety of individual circumstances. Our second daughter was born with Down's syndrome; we were told, very sympathetically, when she was five days old. At that time she was quite ill with jaundice and was being fed through a tube because she was too weak to suck normally. One thing I am quite certain of is that we were in no fit mental state at that time (and for some time afterwards) to make rational decisions about her future. Our minds naturally tended to dwell on the black side, and anxiety was fed by ignorance about mental handicap. If the doctor had thought fit to suggest that our baby should be allowed to die rather than struggle for life, frankly I do not know how I would have reacted.

Fortunately, no such suggestion was made, and we were immediately given a great deal of help and support which enabled us to be rather more optimistic. I am happy to say that our daughter is now a bouncing two-and-a-half year old, and a joy to us all.

In practice the question of life or death is mainly resolved by the doctor, who can at least claim a certain emotional detachment; but doctors act on an unpublished ethical code, and the gray areas are so large that much depends on the attitude of the particular doctor. It is I think unfair both to the doctor and the child to place such a burden of judgment on one person. Particularly worrying is the assumption which seemed to be made in the Arthur case, that rejection of a child by the parents was sufficient justification for permitting, if not causing, the child to die. Surely children are not the exclusive property of their parents, and surely a child's right to life should not depend on whether his or her parents are willing or able to care for him or her? This point seemed to have been settled in another legal case earlier this year when the court stepped in to permit an operation on another Down's baby whose parents had earlier refused consent. The baby lived, and was taken into foster care; perhaps one day her parents will welcome her back to their family.

Some attention also needs to be paid to the means used to permit death. To leave a medical condition untreated is one thing, to sedate an otherwise healthy baby so that it will not demand food, is to me quite another, and quite unacceptable. This is one area where it is clearly in the competence of the medical profession to codify what sort of treatment is ethically justifiable.

Many decisions in this field are based on assumptions, often unstated, about the future quality of life available to a severely handicapped person. This is dangerous ground for two reasons. Firstly, the assumptions may wrong; it is impossible to predict future advances in medical science and technological aids for even the severely handicapped. In any case, the present dearth of facilities for the handicapped reflects a scale of social priorities which could easily alter, and more material resources could greatly improve the quality of life of many disabled people.

Secondly, it seems wrong in principle to allow one human being to place a value on the life of another; this is a slippery slope which has its logical end in Hitler's gas chamber. The problem with death is that it is irreversible; until medical science can overcome that problem, we ought to be very cautious about playing God.

Revised: August 24, 2000.