Sunday, February 23, 2020

Who should survive?



I just discovered this influential 10-minute film online, and I'm a little amazed that it took me this long. I'll let it speak for itself. Here is how David Rothman describes the case that inspired it in Strangers at the Bedside:

Although there is something artificial about selecting a single starting point for this analysis, the case of the Johns Hopkins baby stands out. In 1967 a baby suffering from a digestive abnormality was born in a community hospital at Virginia's Eastern Shore. The infant was transferred immediately to the Johns Hopkins University Hospital, and his doctors discovered an intestinal blockage, a problem readily correctable through surgery. But the baby was also mentally retarded because of Down's syndrome. Upon being told of the situation, the parents refused to give permission for the surgery, and the hospital complied with their wishes. The infant was moved to a corner of the nursery, and over a period of fifteen days, starved to death.' 

In the opinion of several physicians at Johns Hopkins, the case was not all that unusual. It was common knowledge, at least within the profession, that many infants born with spina bifida -- a condition in which the spinal column is exposed and underdeveloped, causing paralysis, incontinence, and, frequently, mental retardation -- never left the delivery room; the chart entry read "stillbirth." (When it later became the practice to intervene aggressively with spina bifida infants, the number of "stillbirths" went down almost to zero.) The Hopkins staff also believed that recourse to the courts was a waste of time because judges would always uphold the parents' desires.

Nevertheless, the baby's death deeply affected the resident who had pulled the feeding lines (William Bartholome), the chief resident (Norman Fost), and the chief of service (Robert Cooke, himself the father of two handicapped children). Indeed, they were so disturbed by the course of events that they took the issue outside the hospital. With assistance from members of the Kennedy family, whose concern for the treatment of the mentally retarded was exemplified in the work of the Joseph P. Kennedy Foundation, they oversaw the making of a short film about the incident, with a ten-minute segment devoted to the case and then a fifteen-minute panel discussion on the ethical principles involved.

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