On the Grounds for Parental Consent in Determining the Treatment of Defective Newborns

Abstract

Recent advances in medical technology have made it possible to substantially extend the life expectancy of defective newborn infants.(1) By the 1960’s application of this technology had become so widespread that it was the common practice of most major United States’ hospitals to offer maximal treatment to all such infants despite the severity of their impairment. By the end of the decade some physicians involved in the care of these children had begun to question the advisability of this practice. Where an infants’ life prospects were, at best, bleak they suggested that nontreatment might be preferable to active intervention. Reservations were voiced most frequently about treatment of the congenital malformation of the spinal cord known as spina bifida myelomeningocele. The infant is born with a lesion in the spinal column and paralysis below the level of the lesion. The higher the lesion the more severe the disability. Controversy soon began to surface in the medical journals between a group of physicians who advocated a policy of selective treatment of infants with such congenital malformations and those who now found themselves challenged to justify the prevailing practice. The controversy grew more complex as it was found that infants selected for nontreatment frequently survived nonetheless and their prognosis was often bleaker than would have been the case if they had been treated initially. Their death could not be accurately predicted.