Wednesday, August 31, 2016

Zika Birth Defects and Euthanasia

By Sherry Colb

In my Verdict column for this week, I write about the dilemma with which Zika virus has confronted those of us who think about abortion in moral terms:  Is it morally acceptable to terminate a late-term pregnancy to avoid giving birth to a child with catastrophic brain abnormalities?  I suggest in my column that because of the stage of pregnancy at which at least some of these abortions will take place, the choice begins to look more like euthanasia than like abortion.

I will not here attempt to tackle the question whether euthanasia of babies afflicted with severe and profound birth defects is morally permissible or whether it ought to be legal on occasion.  I do, however, want to relate two anecdotes that I heard from two people born in the 1960's (the same decade in which I was born).  One said that her parent told the doctor that if there was something wrong with the baby at birth, the doctor should not encourage the baby to breathe.  The other said that her parent was told by the doctor that he (the doctor) did not deliver damaged babies.  The implication in both of these cases was that both parents and their doctors might have been engaging in informal euthanasia many years ago and in a context in which no one could characterize what was happening as an abortion (by contrast to the late-term abortions of Zika-infected fetuses discussed in my column).

Whether I and most of my audience believe that euthanasia of infants is ever acceptable, then, it may happen more than we think.  Estimates vary wildly on what proportion of Down Syndrome pregnancies are selectively terminated (between 30% and 90%), but the proportion is significant.  As I have said, even if this reason offends many people, the pregnant woman should nonetheless retain the bodily autonomy to decide who does and does not get to live inside her womb for nine months. But once we are talking about euthanasia (or neonaticide), the bodily integrity argument drops completely out of the equation, yet the same "reasons" for wanting to terminate may nonetheless motivate doctors and their patients to want to end the life of the baby who is there.  The question then is whether people will act on that motivation.

Let me say clearly here that I think that even if it does take place on occasion, the frequency of euthanasia of birth-defective infants is likely to be low.  This is both because people do feel very differently about euthanasia and abortion, as a moral matter, and because it is unambiguously criminal to kill an infant, regardless of how impaired or otherwise compromised the infant might be. We can see here the impact of the law:  the law both shapes behavior directly (because people do not want to get into trouble) and indirectly (by affecting people's moral views of what is being done). While a generic late-term abortion troubles many people, a majority of respondents to a Harvard poll reportedly indicated approval for post-24-week abortion in the case of Zika-caused abnormalities. The fact that such an abortion might be legal in some places likely played a role in people's responses.  Were they asked instead whether they would approve of euthanasia of Zika-affected newborns, my guess is that very few respondents would say yes.

Despite the ongoing roiling controversies over abortion that seem never to let up, then, the legality of the procedure does seem to have an impact on people's views of the killing of late-term fetuses. When those fetuses are located inside a woman, avoiding a profound disability can qualify as a good reason for killing them (even if the pregnancy does not feel like a physical imposition for the particular woman), whereas when they are located on the outside, unlinked to an "unwanted" or wanted pregnancy, procuring their death is an utter taboo.  In thinking about this, I am led to wonder whether an artificial womb could affect things.  Presumably, at some point, there could be an artificial womb in which fetuses could gestate as a substitute for being inside a woman.  If a Zika fetus, at 24 weeks (or 32 weeks) was clearly developing profound birth defects, then, what would a majority of respondents say about terminating the fetus's life at that point?  Though the stage of pregnancy would be the same, I suspect that the fetus's (baby's?) presence outside the human womb, even in an artificial womb, would change people's perception of the killing from "abortion" to "euthanasia" and thus turn them against it.

Of course, some day, people may come to see euthanasia as a humane way to address horrible abnormalities in infants that will severely compromise their ability to live a fulfilling life.  Until that time (if it ever comes), however, it may well be the very fact that pregnancy conceals the euthanasia target that allows people to express their preference for euthanasia without actually acknowledging that preference to others or to themselves.  Though "abortion" is hardly a value-free word, we thus see that it has far less of a taboo attached to it than "euthanasia" does.  And taboos have consequences.


Joe said...

"the bodily integrity argument drops completely out of the equation"

The 32 week old fetus that is aborted for purposes of euthanasia is a truly special case, even more so than a fetus earlier that might survive (and is sentient) but is much at risk. A fetus at twenty-six weeks, e.g., might survive, but there still is a big chance the fetus won't survive. A fetus at about eight months is different. Risky, perhaps, but in this day and age, generally will survive and thrive.

Still, I don't know if it is "completely" or whatever word we use there no longer about autonomy. The woman is still pregnant and choosing what to do with her body (sentient fetus or not, it's connected to her body). The sentience might trump that in this scenario but a balance is still being made.

Bass Around the World said...

We had to face this when our son was born (at 41 weeks) after a grueling labor that resulted in aspiration of meconium, his lungs shredding and collapsing, loss of O2 to the brain and subsequent brain damage. We feared the absolute worst and felt that the hospital had dropped the ball by not performing a C-section during an obviously problematic birth. At the time, I was outraged that we were never consulted about the heroic measures taken to save our child's life. The last thing I wanted was a half-million dollar bill after they presented us with someone who was blind and deaf and had no chance for any kind of cognitive ability, leading a to a life of 24 hour care and no real interaction with the world, as so often happens with HIE kids.

Luckily, a miracle happened (and the new head cooling technology at Denver Children's, followed by 16 months of intense therapy) and our son is now an utterly brilliant 4 year old (his preschool teacher declared him to be by far the most intelligent kid she's ever met). We cannot imagine life without him. But, in those early days, I was seriously thinking that perhaps the best thing would have been to just let him go. Part of the trauma of that day will always be with me, but every day it is more and more outweighed by the joy his presence brings to us and all around us. And, as he surprisingly showed us without any previous experience, he's a heck of a drummer.

We had already gone through the Down's Syndrome screening, so we didn't have to make that call.