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At least 19 recordsLinked to original sources
PubMed1986

The ballad of Baby Doe: parental discretion or medical neglect?

The Baby Doe legislation generated, over a 3-year period, a "large-scale national seminar" on the rights and interests of handicapped newborns and their parents. In this article, the background for the Baby Doe legislation is provided, the details of what the law says are presented, and the implications of the legislation for medical practice are discussed, including the creation of infant bioethics committees. The overall effect of the Baby Doe law will be to protect the legitimate interests of a few children who would otherwise be mistreated. It will cause some resentment among parents whose interests conflict with their children's survival, among doctors who dislike shared decision making, and among others who resist the intrusion of the state into "private affairs." Yet subjecting life-and-death medical decisions to more professional scrutiny will probably yield better treatment rather than worse treatment in a majority of cases. In addition, it may have further spin-offs that benefit both the professions and society in times to come.

Child Abuse↗
PubMed1988

Neonatologists judge the "Baby Doe" regulations.

The federal regulations now in effect governing the treatment of severely handicapped infants--the so-called Baby Doe regulations--are based on the 1984 amendments to the Child Abuse Prevention and Treatment Act; these regulations require that, except under certain specified conditions, all newborns receive maximal life-prolonging treatment. We sent questionnaires to the 1007 members of the Perinatal Pediatrics Section of the American Academy of Pediatrics to determine their views on the Baby Doe regulations and on whether the regulations had affected their practices; 494 of the members (49 percent) responded. Of the respondents, 76 percent believed that the current regulations were not necessary to protect the rights of handicapped infants; 66 percent believed that the regulations interfered with parents' right to determine what course of action was in the best interest of their children; and 60 percent believed that the regulations did not allow adequate consideration of infants' suffering. In responding to the three hypothetical cases of severely handicapped newborns, up to 32 percent of the respondents said that maximal life-prolonging treatment was not in the best interests of the infants described but that the Baby Doe regulations required such treatment. The responding neonatologists' concerns about the current Baby Doe regulations were similar to those expressed by the United States Supreme Court in rejecting an earlier set of Baby Doe regulations. This similarity suggests that the current Baby Doe regulations should be reevaluated.

Abnormalities, Multiple↗
PubMed2005

Rejecting the Baby Doe rules and defending a "negative" analysis of the Best Interests Standard.

Two incompatible policies exist for guiding medical decisions for extremely premature, sick, or terminally ill infants, the Best Interests Standard and the newer, 20-year old "Baby Doe" Rules. The background, including why there were two sets of Baby Doe Rules, and their differences with the Best Interests Standard, are illustrated. Two defenses of the Baby Doe Rules are considered and rejected. The first, held by Reagan, Koop, and others, is a "right-to-life" defense. The second, held by some leaders of the American Academy of Pediatrics, is that the Baby Doe Rules are benign and misunderstood. The Baby Doe Rules should be rejected since they can thwart compassionate and individualized decision-making, undercut duties to minimize unnecessary suffering, and single out one group for treatment adults would not want for themselves. In these ways, they are inferior to the older Best Interests Standard. A "negative" analysis of the Best Interests Standard is articulated and defended for decision-making for all incompetent individuals.

Abnormalities, Multiple↗
PubMed1984

'Baby Doe' rules. There are alternatives.

The federal government's "Baby Doe" rule has elicited a strong negative response; however, a more constructive option for concerned health care providers would be to formulate reasonable alternatives to such rules. Such an alternative infant advocacy process has been developed within our community. This multistep process, which attempts to optimize individual patient care and provide public accountability, lists (1) six ethical propositions that ensure that decisions are made in the best interests of the infant; (2) five decision-making principles that define physician and parent obligations and ensure that decisions are made only after careful thought; and (3) guidelines for committee review that ensure that decisions are reviewed in a manner that recognizes the rights of the child and the parents as well as society's interest in ensuring that the best decisions are made in matters of life and death.

Congenital Abnormalities↗
PubMed1986

Treating Baby Doe: the ethics of uncertainty.

The ethical tensions inherent in all Baby Doe treatment decisions are compounded by medical uncertainty. Physicians both here and abroad have adopted various strategies. Swedish doctors tend to withhold treatment from the beginning from infants for whom statistical data suggest a grim prognosis. The British are more likely to initiate treatment but withdraw it if the infant appears likely to die or suffer severe brain damage. The trend in the U.S. is to start treating any baby who is potentially viable and continue until it is virtually certain that the infant will die. The "least worst" strategy is an individualized one: starting treatment, gathering data, and then reassessing the decision.

Brain Diseases↗
PubMed1984

'Baby Doe' rulings-review and comment.

The recent controversy over the "Baby Doe" regulations issued by the Department of Health and Human Services represents the culmination of a dilemma that has faced the medical and legal professions for more than a decade. Although they have not been upheld by the courts, the regulations express the position that withholding treatment from defective newborns may constitute discrimination on the basis of handicap and advocate mechanisms for the reporting of such practices. Legislation regarding this issue is pending at both the national and state levels. The rulings have been disputed by many medical and professional groups, which are working to provide acceptable alternatives.

Arizona↗
PubMed1986

The Baby Doe rule: still a threat.

Current federal policy, as reflected in the final Baby Doe rule, will have a chilling effect on the ability of doctors to care appropriately for severely disabled infants. The policy threatens to prolong life unjustifiably for such infants. It will force physicians to violate a duty to do no harm without compensating benefit. And it raises serious problems for the just distribution of health care.

Congenital Abnormalities↗
PubMed1990

The Baby Doe regulations: views from perinatal social workers.

In 1984 the federal government issued the "Baby Doe" regulations, designed to protect the rights of handicapped infants. Members of the National Association of Perinatal Social Workers were asked to evaluate these regulations and were given the opportunity to comment on their impact. The authors present and discuss these comments with respect to the helpfulness of the regulations, physician discretion, parental rights, and the social work role.

Child Abuse↗
PubMed1990

Do the 'Baby Doe' rules discriminate against infants?

This essay consists of a critical examination of the 'Baby Doe' rules with respect to their proscription of references to quality of life considerations as a basis for treatment decisions. It is argued that the rules cannot and should not obviate references to the infant's quality of life. Further, it is argued that there are not sufficient differences between infants and adult incompetent patients to justify the use of quality of life assessments with regard to the latter and not the former.

Humans↗
PubMed1990

Baby Doe regulations and medical judgment.

The potential for conflict between social policy and medical judgment can be examined in relation to the 'Baby Doe' regulations issued by the U.S. Federal Government in 1984. These regulations identify the circumstances in which medical treatment may be withheld from handicapped infants. This article reports on a national survey of perinatal social workers which compared their responses to the answers of physicians to similar questions published earlier. These social workers failed to express a conflict between sound medical judgment and the federal regulations when confronted with three hypothetical cases. The same was true in the published study of physicians but that data was erroneously interpreted as providing evidence of a conflict between medical judgment and federal regulations. On some general opinion statements, the social workers were similar to physicians in their criticism of these regulations but on others they were equivocal. While the majority of responses of social workers to other questions about these regulations was rather similar to the responses of physicians, the social workers were found to be more inclined than physicians to express the view that these regulations were needed to protect the rights of handicapped infants and the view that the physician's practice had been changed as a result of these regulations.

Ethics, Medical↗
PubMed1997

A killing of Baby Doe.

An anencephalic infant died in the Neonatal Intensive Care unit six hours after birth. Eighteen months later, in a discussion of intrusive federal "Baby Doe" regulations with co-workers at the hospital, a registered nurse mentioned that he had found a way to avoid these provisions, and that he had in fact done so on one occasion by killing this particular infant. A co-worker related his story to police, and the "wheels of justice" were set into motion. I describe the chronology of events and the pathologic findings in this case of infanticide, purportedly committed "with mercyaforethought."

Anencephaly↗
PubMed1987

Baby Doe decisions: a hospital manager's perspective.

Profound changes have taken place in the treatment of seriously handicapped infants in hospitals. These changes are examined from the perspective of the hospital manager, looking at hospitals' response to the new challenges of handling "Baby Doe" types of cases, including the formation of Infant Care Review Committees in many hospitals.

Abnormalities, Multiple↗
PubMedDate not supplied

Neonatologists and bioethics after Baby Doe.

The use of hospital ethics committees or infant care review committees has been recommended for difficult decision making. In a survey of military and civilian neonatologists, ethics committees had been established in 27 of their 28 hospitals and fewer than 50% had infant care review committees. Despite the frequently of potential cases for committee review, they were seldom consulted. Inquiry into the educational background of respondents revealed that at least 62% of neonatologists had received ethics education during their professional careers. Most made difficult decisions in conjunction with parents or used a multidisciplinary patient care conference. The use of these conferences antedated any federal regulations. Sixty-seven percent indicated that the Baby Doe regulations had affected neither their thinking about ethical issues nor their practice. In 13 different hypothetical cases in delivery room, intensive care nursery, and long-term care settings, the provision of comfort care, limited care, or withdrawal of support was noted by a sizable percentage of neonatologists; exceptions included meningomyelocele and trisomy 21. The need for ethics committee input in decision making for neonates is questionable.

Attitude of Health Personnel↗
PubMed1989

Baby Doe, Congress and the states: challenging the federal treatment standard for impaired infants.

In its amendments to the Child Abuse Prevention and Treatment Act, Congress set forth a strict standard for treatment of impaired infants. The statute, shaped by right-to-life groups and certain medical organizations, calls for aggressive treatment in virtually all cases, regardless of the degree of suffering imposed and the burdens and risks involved. The federal rule evidences deep distrust of parental decisionmaking, relegating most parents to a nonparticipatory bystander role. Congress did not make its rule binding on the states. Rather, it conditioned the receipt of federal funds upon incorporation of the rule into each state's law. Most states have accepted the condition, largely through rulemaking by state child abuse agencies. This article challenges the authority of state administrators to promulgate these rules, and argues that state constitutions, little mentioned in the Baby Doe debate thus far, may prohibit many states from adopting the federal standard. Ordering medical interventions that perpetuate extreme conditions of physical and mental devastation, subjecting infants to grave suffering for uncertain benefits, and depriving parents of virtually all decisionmaking power violates the norm of governments constitutionally committed to individual liberty, human dignity and family autonomy. A constitutionally sound approach to this issue would permit careful, ethical deliberation, attention to the individual circumstances of each infant Doe and a reasonable degree of parental control.

Child Abuse↗