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Resolving arguments about the sanctity of life: a response to Long.

Thomas Long has argued that there is an irreconcilable metaphysical difference between the views of those who, like ourselves, believe that on quality-of-life grounds it is sometimes justifiable to end the life of a severely handicapped infant, and those who, like Paul Ramsey, reject this view. Because of this metaphysical difference, Long considers it impossible for our arguments to refute Ramsey's position. We disagree.

Persons with Disabilities↗

Unfinished feticide: the ethical problems.

Dr. Jansen's paper raises three main issues. The one with which he himself is most concerned is the question of which methods of abortion are ethically right, and whether methods which risk the birth of a damaged baby are wrong. But there are two others: first, how the (originally unintended) birth of a live but damaged child alters the moral situation, and secondly, whether the overcoming of sterility by inducing a multiple pregnancy in which some of the fetuses have to be killed in order for any of them to survive is at all morally acceptable.

Abortion, Eugenic↗

The case of Medea--a view of fetal-maternal conflict.

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation.

Abortion, Eugenic↗

Symposium 1: The Arthur case--a proposal for legislation.

Following the acquittal of Dr Leonard Arthur in the case of the Down's syndrome infant the co-authors of the first paper in this symposium prepared a draft bill on the treatment of chronically disabled infants which has since been informally commended by the Director of Public Prosecutions. A second contributor, a law student, also argues for legislation as being the most effective way for society to have its standards clarified and observed. In a final paper Dr Havard, Secretary of the British Medical Association, opposes legislation believing it would raise far more problems than it would resolve. The first article was originally published in the Law Society's Gazette.

Down Syndrome↗

Fear of pregnancy and childbirth.

Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known.

Abortion, Induced↗

A study of filicidal men.

Twelve filicidal men were examined on a forensic psychiatric service. The majority suffered from severe mental impairments due to psychosis, neurological disorders, substance abuse, or mental retardation. Most of the filicidal acts committed by these chronically impaired men resulted from isolated explosive behavior.

Adult↗

A systematic investigation of 16 cases of neonaticide.

OBJECTIVE: Neonaticide, or infant murder on the day of birth, is often preceded by denial of pregnancy. The preponderance of case reports of neonaticide describes a pattern of pregnancy denial, dissociation, and ego disorganization. The author systematically investigated the clinical characteristics of 16 women charged with homicide in the United States after alleged neonaticides. METHOD: The women received a psychiatric evaluation and were administered the Dissociative Experiences SCALE: RESULTS: Nearly all of the women reported similar precipitants and symptoms, including depersonalization, dissociative hallucinations, and intermittent amnesia at delivery. CONCLUSIONS: The characteristics of the women in the study were similar to those reported in the literature on neonaticide. The existence of this common pattern suggests that treatment strategies can be designed for women at risk for neonaticide.

Adolescent↗

Child murder by mothers: a critical analysis of the current state of knowledge and a research agenda.

OBJECTIVE: Maternal filicide, or child murder by mothers, occurs more frequently in the United States than in other developed nations. However, little is known about factors that confer risk to children. The authors review the literature to identify predictors of maternal filicide and identify gaps in knowledge about maternal filicide. METHOD: Databases were systematically searched for studies of maternal filicide and neonaticide (murder in the first day of life) that were conducted in industrialized countries and were published in peer-reviewed, English-language publications after 1980. RESULTS: Women who committed filicide varied greatly by the type of sample studied. Neonaticide was often committed by young, poor, unmarried women with little or no prenatal care. CONCLUSIONS: The results of the review suggest that little is known about the predictors of maternal filicide and that a systematic, focused program of research on reliable markers for maternal filicide is needed to better prevent these events.

Adult↗

The use of paraverbal therapy in treating an inaccessible, traumatized child.

Severely traumatized children are often incapable of responding to traditional psychotherapy. Paraverbal therapy has been shown to render a number of such children responsive to the communicative aspects of the method, with the result that their maladaptive behavior is concomitantly ameliorated. Others, such as the child presented herein, have needed additional traditional therapy.

Adaptation, Psychological↗

Mentally ill mothers who have killed: three cases addressing the issue of future parenting capability.

Many parents with severe and chronic mental illness lose custody of their children due to child abuse or neglect. These children may linger in foster care for long periods of time until decisions about custody are made. Recent proposals to shorten the time that children remain in the foster care system include the use of categories of abuse to guide decisions about custody. One proposal has been to "fast-track" cases involving parents with long-standing mental disorders by automatically terminating parental rights. This approach assumes that a severe and chronic mental disorder is incompatible with safe parenting. This report describes three cases of mentally ill mothers who lost custody of their children after they killed someone. The mothers were nonetheless found to be at low risk for future child maltreatment and violence according to evaluation with two current methodologies, Parenting Risk Assessment and Risk of Violence Assessment. The cases question the assumption that mental illness is incompatible with safe parenting and underscore the fact that evaluation of the parenting competency of mentally ill parents is rarely clear-cut.

Adolescent↗