For decades, medical experts have conducted extensive discussions on the treatment of severely disabled newborns. Many scholars have discussed their opinions from different perspectives, such as clinical practice, law, psychology, and ethics. The deontology of the medical field argues that doctors should fulfill their duty to save lives and they should take action to achieve this goal, at all costs. This kind of reasoning should be affirmed under normal circumstances. As long as there is hope for treatment, doctors should provide treatment. However, deontology does not respond well to the chances of success, the price paid is much, who will pay the cost, etc. In addition, modern medicine is no longer an individual behavior, but a huge social undertaking. Therefore, modern medical ethics cannot limit the ethical relationship to doctors and patients, and must expand the horizon to the people, society, and even the future generations. Therefore, the traditional theory of obligation cannot resolve the ethical dilemma of severely disabled newborns.
For the treatment and treatment of severely disabled newborns, people always strive to seek regulation and support of the law. However, the proactive intervention and end of an innocent, surviving human body in an institutional manner may be difficult to achieve in the near future. Therefore, in the treatment of severely disabled newborns, the legal measure also demonstrates passiveness and helplessness. Severely disabled newborns are defined as genetic, congenital or traumatic neonates with birth defects. These newborns have medical problems that cannot be corrected and cured effectively, and some die within a short period of time. Others can sustain life with the help of medical technology but completely lose their motion and self-care ability. Others suffer from severe mental retardation and cannot lead an ordinary life like other people. There are different views regarding how such newborns should be treated. In this essay, a pro-euthanasia view and a pro-treatment view will be compared. These perspectives lead to the conclusion that a combinative approach of deontology and utility should be adopted to resolves the ethical dilemma.
The pro-euthanasia view basically supports the withdrawal of treatment for severely disabled newborns. The quality of life argument is presented first: “In our experience, continuing feeds and fluids makes many dying babies worse. The dying process is prolonged (Campbell 283).” With the development of medical science, modern medicine has made clear judgments on the degree of defects, treatment methods, and prognosis of most newborns with imperfections and has established corresponding operating standards. For example, mild malformation does not affect the development of children’s self-consciousness, and modern medicine is fully capable of treating and correcting children. Therefore, such disabled newborns have the same rights as normal people and cannot be used as an excuse for any reason. Severe malformation causes newborns with defects to die within a short period of time after birth, inability to develop into adulthood, or cannot develop self-awareness. These severely disabled newborns will not live as meaningful individuals and therefore it is justified to stop active treatment for them. Therefore, “withholding feeds and fluids is sound palliative care for many dying babies (Campbell 283).”
Dignity is the most precious and sacred foundation in human life. We should first consider the maintenance of their dignity for the newborns with disabilities. In accordance with the principle of the dignity of life, doctors must actively treat newborns with impaired health who are able to develop “self-consciousness” with hope for treatment. Hospitals, families, and society should work together to safeguard the interests of children, maintain the dignity of children, and support their future life. However, for children who do not have hope for treatment, and who will die shortly after birth, doctors must not arbitrarily dispose of or arbitrarily discard them, and should minimize their suffering. “Caregivers who view quality‐of‐life judgements as unacceptable criteria for deciding to withdraw treatment usually accept that life‐sustaining treatments are not morally mandatory in babies for whom death is ‘inevitable’ (Campbell 280).” The pro-euthanasia argument believes that comfort in dying is an important part of life quality and dignity, and newborns enjoy these rights, too.
Considering the maximization of utility, the principle of social public welfare is based on the principle of morality determined by whether the behavior is based on the public interest. The actual situation and future development trend of modern medicine determine that medicine should derive from the long-term interests of society and all human beings. Medical activities are not only beneficial to patients but also beneficial to society, human beings and future generations. Therefore, public welfare includes the double-layer meaning of obligations and utilitarianism. The public welfare principle not only emphasizes that the doctor’s duty to patients, it also emphasizes the medical obligation to society. As questioned by the pro-euthanasia view: “Do caregivers really have a mandate from their society to use such large resources when returns are so poor? (Campbell 277).” The principle of public welfare borrows from the utilitarian principle of “the greatest happiness of the greatest number of people” and transforms it into the basic principle of regulating ethical decisions. Since there are only limited medical resources in the current society, letting go of one disabled newborn may bring hope to more newborns with better chance of life.
Finally, the pro-euthanasia view also brings a counter-argument against the “slippery-slope argument”. This slippery-slope argument makes an analogy between enacting a new policy and a slippery slope. Although the policy can prove of its own rationality, but its implementation may lead to a series of acts with bad consequences, so it is best to not take this risky first step. “Such arguments appear to say to the baby, “As far as your interests are concerned it would be morally best if we induced a quick and painless death. But if we do, it will launch the rest of us down a slippery slope. So, put up with your distress, and save us all from slippery slopes (Campbell 283).” There may not be a clear link between “crimes” of kindness and non-benevolent killings, from reasonable killings to irrational ones. This point of view only points out a possibility, and it does not give any strong correlation leading directly to the extremes. Even if this possibility exists, it is only a legal issue and cannot be used as a basis for opposing the moral rationality of newborn euthanasia.
On the other hand, the pro-treatment side believes that the consideration of waiving the treatment of severely disabled newborns should never be based on the practical value. The right of life lies in its essence and not in the practical value. “If she lives, she will have interests. (Wilkinson 458).” Considering the human right to life with practical value does not work ethically. A migrant worker is consistent with a scientist in the value of the right to life. Dividing life into valuable and worthless only not breaches social moral values, but also provides grounds for further cruelty. Therefore, humanity should embody the common values of the human social and moral community from the action of treating neonates with disabilities. In addition, it is impossible to conclude a life is not worth living, simply because it is someone else’s life. “Our capacity to know or even imagine what the internal experience of life is like for those who are most severely affected is extremely limited (Wilkinson 457).”
Although medicine has now established clear treatment standards for some of the disabled newborns, it is only limited to making decisions about extreme situations. Many defects are not as simple as those defined by the rules, and the unknown and breakthrough of medicine itself is also constantly changing the situation. For severe disabilities, medicine may be able to create miracles that will allow newborns to survive and reach a certain level of mental and physical strength, but perhaps medicine will only receive death or meaningless life at a great price. In this regard, medicine itself cannot be the answer, people can only rely on social standards to form the final choice. “Intellectual disability per se does not provide grounds for withdrawal of intensive care from newborn infants. (Wilkinson 458).” The pro-treatment side also considers the values of the family, which are of great importance in the decision making.
For the individual patient, the pain of the treatment process and the comparison of the quality of life in the future should be made. For the family of the child, the cost of the treatment given by the family and the comparison of future children’s benefits to the family, and for the society may be considered. “The things that make it worthwhile in their eyes would depend on the specific things in life that the parents value. (Wilkinson 458).” In addition, the comparison of recent value with long-term value, local value and overall value is also required. If the gains and distributions of benefits have positive values, the behavior has moral significance, and when the net values are negative, people should therefore decide to replace active treatment with corresponding measures. This is also morally significant.
In response to the utility-driven pro-euthanasia approach, the utilitarian viewpoint is to invest limited health resources in the most needed patients and avoid waste. However, utilitarianism tends to breed selfishness, leading to the treatment of all individuals from a utilitarian point of view, even if it is only mildly disabled. Whether paternalism can truly represent the true will of a disabled newborn requires comprehensive consideration. The original target of responsibility is the child. Parents have an obligation to his children. In this irreversible relationship model, it is the weak who claim asylum, and the parent who has aspirant responsibility is the ability to protect. Since the baby does not have complete self-awareness and cannot independently assert his or her own life and interests, parents are legitimate agents of severely disabled newborns. Once the treatment fails to meet the parents’ expectations, or if the baby’s own quality of life cannot be improved, ethical dilemma emerges.
The main favoring treatment are: First, life must be maintained; Second, moral pressure. In comparison, parents give up their treatment first because of economic pressure, and second, they cannot make predictions about their children’s future. Some parents insist on the treatment of children with disabilities. However, children up to the age of 6 are still unable to take care of themselves. Their intelligence is extremely low and parents are leading painful lives. It can be seen that whether paternalism can truly represent the interests of children, especially the right to life, requires careful consideration. Once euthanasia is allowed for the severely disabled newborn, it is highly possible for parent to deliberately give up treatment, especially for economically underdeveloped regions. This behavior will undoubtedly undermine the already fragile moral foundation.
Overall, traditional medical deontology should not be completely abandoned. The two aspects of deontology and utilitarianism should be combined to solve the problem of the treatment of severely disabled newborns. The deontology emphasizes the uniqueness of the motives and obligations of good, and thus clearly defines the moral origin for people to respect life, and to protect life. Utilitarianism uses the utility value of predicting and calculating behaviors to judge the feasibility of an action, and then clarifies that the consequences of medical behavior should bring happiness to individuals, families, and the society, and benefit the interests of the most people. The deontology emphasizes on life and justice, and the utilitarianism emphasizes on reality and total benefit. Both theories should be combined, so that they become more persuasive when dealing with special ethical situations such as severely disabled newborns.