Anticipating the immanent birth of their child is, for most people, a high point in life. Tragically, in some cases what is normally a joyful event can become a traumatic episode when the newborn turns out to be severely defective. Fortunately this is not very common; roughly 3% of all US births. Keeping such a newborn alive generally entails costly special treatment, after which survival is often for a period under one year. During this time, the infant may be in almost constant pain and the parents may be required to devote a great deal of time and energy caring for it, often to the detriment of other children in the family.
Three or four decades ago, the situation was quite different. Techniques for treating many of the common defects were much less developed, so that, in many cases, the newborn did not survive more than a few days. Perhaps more important, physicians realized that, even if the newborn could be kept alive, its chances for a reasonably decent life were small. Therefore, usually, but not always, in consultation with the parents, many quietly took steps to allow the newborn to die.
Nowadays physicians cannot do this, even with the consent of (or at the request of) the parents. Right-to-life organizations and organizations representing handicapped people have acted to get laws and regulations instituted and enforced that make it very difficult to allow a newborn to die, regardless of its condition and the wishes of its parents. Is this a good thing?
Virtually everybody feels protective toward children. Among those of us who are parents and grandparents, this feeling is particularly strong. It is natural to feel that it is a terrible thing to fail to do everything possible to prevent the death of a child, even a newborn. Certainly one would expect the parents of such a child to have very strong feelings about this. So why have so many parents confronted with this situation, often after much agonizing, asked that their newborn be allowed to die? Discussion of this question will take us into some interesting territory and shed light on other related and important issues.
One obvious reason for parents to allow their newborn to die is to spare it pain and misery, followed in many cases by an early death. Another factor is that such infants require far more parental care. If there are other children in the family they may suffer serious neglect as a result of the overburdening of their parents. If the impaired infant survives for a longer period, more than a few years, the parents often cannot afford to have additional children, because of the drain on their time, energy, emotional, and financial resources. (The organizations campaigning for laws and regulations to require all-out efforts to keep defective newborns alive do not generally offer assistance to the parents.)
The cost of surgical and other treatment necessary to preserve the lives of these infants is often enormous, well beyond the capacity of middle income people. The burden therefore is largely borne by public funding. Given that the number of such cases arising each year in the US is now roughly 120,000, the annual cost of treatment is of the order of many billions of dollars. Spending a fraction of this amount on vigorous programs to provide proper care and treatment of impoverished, often very young, uneducated, prospective mothers would, by substantially reducing the number of births of defective newborns, save, not only a lot of money, but more important, a great deal of grief. Similar benefits would accrue from education about proper nutrition and avoidance of behaviors that often cause serious birth defects.
But what about the newborns themselves? Don't they have rights that should be respected? In particular, doesn't each of them have a right to life?
This is the heart of the matter. When should we assume that a human acquires a right to life? There are those who believe that this occurs at the moment of conception. Others favor some more advanced point of embryonic development, and still others would put that point at the moment of birth. My position is that this right does not exist until a child has developed to a point where it has some notion that it might die and could therefore suffer from fear of being killed. This point is not easy to ascertain precisely, and certainly varies a great deal among individuals. So a very conservative boundary should be assumed, perhaps a month after birth, well before that point could possibly be reached. Since my justification of this position is the foundation for what follows here, I urge readers to check out these arguments, which can be accessed by clicking here [Unger1]. Also pertinent to the current discussion is a follow-up article, applying these arguments to abortion (which is relevant to the issue of newborns); click here [Unger2].
The basic position taken in the above works can be summarized briefly as follows. The absence of a strong, well enforced, and well known law against killing people would cause painful, well justified, anxiety among all who are capable of understanding that their lives are not protected. It is important, for peace of mind, that such protection not be withdrawn during our lifetimes, even if our mental faculties deteriorate to the point where we can no longer understand that such has taken place. Otherwise, particularly as we age, we would dread any gradual loss of our mental faculties as life threatening. This justifies strong legal protection of the lives of people who have attained this capacity for understanding and those who have, at some time in the past, attained it. Clearly it does not cover those who have not reached that stage of development, e.g., those less than a month old. Protection of their lives is justified by the feelings of their parents about them.
The application of these ideas to the situation of defective newborns is summarized below.
When confronted with the fact that their newborn is severely defective, parents must consider, usually in consultation with physicians, and perhaps others, several important factors. These include their estimate as to the extent to which it is currently suffering and may be expected to suffer over time, its prospects for a decent life, and the effects attempting to raise this newborn would have on themselves and on any other children they now have or might have in the future.
Estimating prospects for a decent life, relevant if the life expectancy exceeds a year or two, is very difficult, as it usually involves great uncertainty and requires judgments about what constitutes a decent life—a very subjective matter. Depending on the severity and nature of the handicap, the prospects vary considerably. Furthermore, there are examples of severely handicapped people who overcome the odds against them and live happy, constructive lives.
Given similar situations, different people may arrive at different conclusions. Some parents may wish to have everything possible done to keep their child alive as long as possible. Other parents, under the same circumstances, may wish to have the life of the newborn ended as soon as possible, often with the intention of trying to conceive another child. The wishes of both should be respected and implemented to the extent feasible. A somewhat different analysis, arriving at the same conclusion, is presented in a concise, well written essay by [Smoker].
The above principles regarding protection of life have implications beyond just abortion and the treatment of defective newborns. Consider, for example the unpleasant fact that every year, there are several hundred known instances in the US of mothers, usually unmarried teenagers, who, shortly after giving birth, kill their newborns and hide the bodies [Pinker]. It is believed that the known cases constitute only a fraction of the total number of such cases. Clearly this is a desperate act, flying in the face of the normal feelings of mothers. It can stem from a variety of causes. The pregnancies in virtually all such cases are unintentional and often the girls do not know that they are pregnant until they actually give birth. Some of the pregnancies have been the result of rape or incest. The girls usually do not have supportive parents, they usually have no idea as to how they could support themselves and a child, are clearly in no position to raise children properly, and the fathers are nowhere in sight. Sometimes the women are older, struggling to bring up other children under dire financial circumstances. (There are also cases of mothers killing older children, but this is an entirely different matter, properly falling into the category of homicide, as the victims have already acquired the right to life.)
The killing of a newborn (neonaticide) is an act that we all instinctively abhor, and, under most circumstances, this revulsion is appropriate. The basic reason we feel this way is that we have in mind images of our own children, or grandchildren, or those of friends or relatives at that stage of life. Obviously the defective newborn situation discussed above is rather different. The above-mentioned cases of child-mothers call for further thought. The key point is that, in such cases, the mother does not want the infant. Assume that, as is usual in such cases, neither does the father. What kind of future would lie ahead for newborns whose parents do not want them?
Our prisons are filled with such people. While there are, indeed, many examples of wonderful people, living fulfilling lives, despite having grown up in miserable circumstances with uncaring, or missing, parents, they are the exceptions, illustrating the remarkable resiliency of humans. Many more victims of such conditions find little happiness, and often inflict a great deal of misery on others thru criminal behavior.
What can be done about neonaticide? A principal goal should be to head off births of unwanted children. Urging teenagers to refrain from sexual intercourse is one approach. It might work for some youngsters, so it is not a bad idea to try it. But experience indicates that it is far from an adequate solution. The next line of defense is to ensure that teenagers have access to contraceptives and information regarding their use. Finally, since there will surely be instances of failures of both of these approaches, abortions should be available as the last resort.
What about unwanted births occurring despite all these measures? Here is where opponents of abortion, and even contraception, can make a useful contribution. They could set up organizations to find people anxious to adopt children, and make their existence widely known so that desperate mothers of unwanted children have a better alternative than killing them. Of course, such organizations do exist now, but they do not seem to be adequate—they need bolstering.
If, despite all this, some mothers nevertheless kill their newborns, this should not be treated as homicide (for the reasons cited above), but rather as a lesser offense. This may seem to be a strange attitude, but actually it is consistent with laws in Great Britain and many European countries. Historically, the killing of newborns was commonly practiced, on a large scale, for a variety of reasons all over the world in both advanced and primitive societies, including ancient Greece and Rome, China, India, nineteenth century Japan, and in both arctic and tropical areas of the world. That fact does not, by itself, justify the practice, but it does show that it is not some bizarre new idea.
Some point out that ostensibly benign efforts to "purify" the human race by eliminating people with all kinds of defects morphed into the Nazi onslaught on "inferior" people of all types, ranging from handicapped people to Gypsies to Jews, and culminating in the holocaust. They claim that implementing the kind of thinking presented here could put us on a slippery slope leading to wholesale slaughter. I think not. The Nazi approach, from the outset, entailed the government condemning people, of all ages, to death, in order to strengthen the nation. By contrast, the argument here is in support of parental rights to make decisions about their newborns without interference from government or any other organizations. A case is made that there should be strong laws protecting the lives of everybody who, currently, is or who in the past was, capable of understanding that they might be homicide victims. Instead of posing a threat to the handicapped, whether adults or small children, these arguments make it clear that their lives merit the same degree of protection as do those of anybody else's.
Today, most religions of the world do not look favorably on contraception, abortion, or neonaticide, altho, within each there are substantial disagreements as to what is permissible. For example, some Protestant ministers believe abortion at any time and for any reason is wrong. Others approve of abortions prior to 12 weeks of pregnancy, and still others approve even later abortions. Various views are held among clergy as to the weight to be given to indications that the fetus is seriously defective or that the health or life of the mother is at risk, or that the pregnancy was the result of rape or incest. These views are generally derived from readings of holy scripture, generally involving beliefs as to when a fetus acquires a soul (or some equivalent, depending on the religion). Because the scriptures of just about all religions are not explicit on these matters, there is room for considerable variation in interpretation [Maguire].
There are substantial differences between what the preachers preach on these matters and the beliefs of their congregations. For example, altho the Catholic Church has, for many decades, strongly opposed both contraception and abortion, many practicing Catholics do not accept these teachings [PRNewswire].
Many religious people fervently believe that abortion is terribly wrong, and a large subset of this group feels strongly that contraception also entails the killing of a person. They have every right to publicize their views on these matters and to try to persuade others that they are valid. But, since we live in pluralistic society, with separation of church and state, efforts to force others to act in accordance with our religious views that they do not share are not appropriate.
It is ironic that the Reagan administration, purported champion of family values, one of whose principal slogans was, "get the government off our backs", promulgated government regulations to compel hospitals to perform surgical procedures on seriously defective newborns over the objections of their parents [Kuhse].
In the preceding reference, in addition to a lot of interesting and relevant background material, the authors, Helga Kuhse and Peter Singer, express views similar to, but not quite the same as, those expressed in this essay. Another Singer book dealing with this topic is well worth reading [Singer].
Helga Kuhse, Peter Singer, "Should the Baby Live? The Problem of Handicapped Infants", Oxford University Press, 1986
Daniel C. Maguire, "The Moderate Roman Catholic Position on Contraception and Abortion", The Religious Consultation on Population, Reproductive Health and Ethics
Steven Pinker, "Why They Kill Their Newborns", New York Times, November 2, 1997
PRNewswire, "New Harris Poll Finds Different Religious Groups Have Very Different Attitudes to Some Health Policies and Programs", PRNewswire, October 20, 2005
Peter Singer, "Rethinking Life and Death: The Collapse of Our Traditional Ethics", St. Martins Griffin, 1994
Barbara Smoker, "On Advocating Infant Euthanasia", Free Inquiry Magazine, Volume 24, Number 1, 2/13/2004
Stephen Unger-1, "Why Should Killing be Illegal?", Ends and Means, September 26, 2007
Stephen Unger-2, "Killing People Is Wrong: What About Abortion?", Ends and Means, October 16, 2007
Comments can be emailed to me at unger(at)cs(dot)columbia(dot)edu
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