THE ETHICAL CRITERIA INVOLVED IN DECISIONS TO ACCEPT OR FOREGO TREATMENT OF HANDICAPPED NEWBORNS (NONTREATMENT, ALLOW TO DIE, QUALITY OF LIFE, SANCTITY, PASSIVE EUTHANASIA).

摘要

This dissertation attempts to answer the question: ON WHAT BASIS IS IT ETHICAL TO FOREGO OR CEASE TREATMENT OF A HANDICAPPED INFANT? A survey of the literature yields a spectrum, which can be subdivided into a fourfold typology of possible standards: (1) A Medical Indications Policy; (2) A Contemporary Approach to Ordinary/Extraordinary Means; (3) Projected Quality of the Patient's Life; (4) A Socially-Weighted Benefit/Burden Calculus. The operative components are benefit, burden, patient's best interest, and social factors. How these are defined, prioritized, and "incorporated in" or "excluded from" the ethical calculus constitutes the methodological distinctions among them. Each of the succeeding chapters presents one of the four proposed "types"--its advocates, their criteria, and specific case applications. Each chapter concludes with a critique of the proposed position.;Contemporary proponents of the Ordinary/Extraordinary Means distinction (Ch. 2) broaden the criteria to allow excessive burdens, related specifically to the use of proposed means, to outweigh even the potential benefit of the life-prolongation itself. While this standard is applauded for advocating a broader interpretation of the patient's bene esse, it is criticized for definitional confusion, a false sense of means-related objectivity, and for excluding excessive patient burdens related to the handicap itself, even if merely "perpetuated" by relatively neutral means.;Those advocating the use of a Projected Quality of the Patient's Life standard (Ch. 3) believe that an extremely burdened "quality of life" for the patient is sufficient to warrant foregoing further treatment. Accepting the basic methodology of this approach, the author criticizes those labeled "broader interpreters" for demanding as a prerequisite a projected quality of life too near normalcy and those labeled "more restrictive" for their tendency to exclude social factors altogether from a determination of the patient's holistic best interest.;Finally, the proponents of a Socially-Weighted Benefit/Burden Calculus (Ch. 4) allow net social utility to outweigh a newborn's rightful interest in treatment. With a bow to their incorporation of social factors, they are criticized both for shifting the focus of ethics in medical practice from a quasi-exclusive patient-centeredness to a socially-weighted calculus as well as for their tendency to deny the inherent dignity and personal rights of every infant, irrespective of handicaps.;A Medical Indications Policy (Ch. 1) asserts that if a treatment will be medically (i.e. physiologically) beneficial, it is thereby morally obligatory. With due respect for its impassioned defense of inherent human worth, this approach is criticized for so equating the patient's best interest with the physiological as to truncate the meaning of the patient's well being.;In the concluding chapter the author sets forth his own position, a variation on the projected quality of the patient's life standard.