You don't say

In the LATimes, Peter Singer defends ...well, you know what

One thing is undisputed: Infants with severe problems are allowed to die in the U.S. These are infants in the first two of the three groups identified by Verhagen and Sauer. Some of them — those in the second group — can live for many years if intensive care is continued. Nevertheless, U.S. doctors, usually in consultation with parents, make decisions to withdraw intensive care. This happens openly, in Catholic as well as non-Catholic hospitals.

I have taken my Princeton students to St. Peter's University Hospital, a Catholic facility in New Brunswick, N.J., that has a major neonatal intensive care unit, where Dr. Mark Hiatt, the unit director, has described cases in which he has withdrawn intensive care from infants with severe brain damage.

Among neonatologists in the U.S. and the Netherlands, there is widespread agreement that sometimes it is ethically acceptable to end the life of a newborn infant with severe medical problems. Even the Roman Catholic Church accepts that it is not always required to use "extraordinary" means of life support and that a respirator can be considered "extraordinary."

The only serious dispute is whether it is acceptable to end the life of infants in Verhagen and Sauer's third group, that is, infants who are no longer dependent on intensive care for survival. To put this another way: The dispute is no longer about whether it is justifiable to end an infant's life if it won't be worth living but whether that end may be brought about by active means, or only by the withdrawal of treatment.

Comment from the emailer:

A few points on this terrible but unsurprising oped from Peter Singer:

     Singer does not differentiate between withdrawal of treatment intended to kill and lethal overdoses. Ironically, he does have a point here and is more honest than the US ethicists who promote withdrawal of feedings, antibiotics, etc. but who criticize lethal injections. No wonder very few doctors or family members who kill their terminally ill or disabled loved ones are prosecuted!

    Note how Singer uses the Catholic Church to buttress his view. Unfortunately, we do have problems in some Catholic hospitals and with some Catholic ethicists. But this is a reason to insist that Catholic institutions adhere to the highest ethical principles rather than sink to the lowest common denominator.

   In 1982, the Baby Doe controversy galvanized both prolife and disability groups to protect newborns with disabilities and led to the President Reagan's intervention and the Baby Doe regs and the later Child Abuse Act Amendments of 1984. Unfortunately, the courts pretty much eviscerated these positive developments which would have helped protect US infants with disabilities today.

   Lastly, infant mortality in the US is said to be unacceptable but if infants are being deliberately killed either directly or indirectly, then these statistics are essentially meaningless in terms of health care progress.

Comments

[Tim Young]

"The dispute is no longer about whether it is justifiable to end an infant's life if it won't be worth living"

Mr Singer is completely mistaken if he thinks this nonsense is Catholic teaching. Catholic teaching is about "extraordinary measures", not about whether the life in question is "worth living". I believe some germans had a similar phrase, "life not worthy of life".

[lerner]

Singer has long played this trick. He refuses to acknowledge any distinction between withdrawing extraordinary measures and active killing. He believes that the two practices are morally identical and that only a hypocritical failure of nerve prevents us from active killing. It's really tiresome to continually argue these points, but a silly position repeated often enough begins to be accepted. Singer is really relentless in his zeal.

[al]

Exactly what is the difference between "withdrawing extraordinary measures and active killing"?

[T. Marzen]

lerner:

You say that Singer "refuses to acknowledge any distinction between withdrawing extraordinary measures and active killing." But any distinct in this regard all depends on what you mean by "extraordinary" (or "disproportionate") measures, doesn't it? After all, withdrawing or withholding ordinary or proportionate measures is just as much euthanasia as providing a lethal injection.

Moreover, the core moral prohibition is on acting or FAILING TO ACT with the intention to cause death. So even withholding/withdrawing extraordinary means is prohibited if the intent is to cause death rather than to relieve the burden caused by the means employed.

Let's face it: Singer is right to the degree that "quality of life" and "let's-end-life-to-end-suffering" are often the real reasons for withholding/withdrawing treatment behind the mere pretext that the means employed are "extraordinary." I mean, how can anyone argue that antibiotics are extraordinary means these days?

[chris K]

The distinction seems to me simply to either allow nature to takes its course while attempting to ease pain vs a lethal injection which interrupts nature being the active catalyst, and substituting an active measure performed with the intention to kill and subvert nature.

[T. Marzen]

chris K:

"Let nature take its course"? Many or most of us would be dead now if it were merely permissible to let Nature rule. Besides, we are part of Nature, and it is our nature to alter Nature's course to preserve our lives and those of our children. In fact, is our moral obligation to use at least ordinary means to overcome Nature's progress toward death. Aren't parents whose child dies because they refused to secure ordinary medical treatment for the child as guilty of murder as parents who smother the child?

Anyway, I question whether the Romance of Natural Death that seems so commonly accepted these days is compatible with Catholic or Christian belief. Is death ever "natural" other than in the sense that it is inevitable? And what did St. Paul mean by his characterization of death as the "final enemy"? This "natural death" business seems to embrace surrender to the enemy rather than triumph through resurrection and eternal life. There is something piously sentimental but ultimately perverse about it. For one thing, we never invoke it unless we first decide that someone else is better off dead, and I'm not sure that this is ever a decision that it is proper to make.

[ita o'byrne]

I'm paraphrasing here but Fr.Richard John Neuhaus in an issue of First Things awhile back wrote that the only 2 people who really got what's at stake in the culture of life/death fight are Pope JP2 and Peter Singer. Singer doesn't beat around the bush about where he hopes we're going and neither does the pope. Unfortunately for the world it seems that in the West Singer's POV is prevailing.

[Marc]

T.,
Aren't parents whose child dies because they refused to secure ordinary medical treatment for the child as guilty of murder as parents who smother the child? I think we should be very careful not to overstep the bounds of authentic Catholic teaching here. In some ways it is very laudable to be so adament about the value of life, but we shouldn't pretend that we don't live in a fallen world or that there isn't a difference between neglect/unintentional homicide and direct intentional homicide. There are many cases in which it is perfectly reasonable and allowable for a Catholic to allow death to come. There are also cases where it is simply not excusable to give up. But, just because there are many black and white cases doesn't mean the shades of grey cases don't exist. To pretend that they don't really hurts our credibility and our ability to advocate for a culture of life.

[al]

Marc,
There are "sins of omission" is Catholic Doctrine.. Mortal sins even.

[chris K]

t. Marzen,

The topic here is the use of extraordinary means which of itself begins to cause more harm than good. And we are talking about the direct killing of infants capable of living without extraordinary means. My allowance for nature to be trusted in some cases isn't anything like your knee jerk response or unconsidered generalization. Nature taking its course today includes the "natural" discoveries to enhance nature, like antibiotics, to win over disease or those things that go against the natural ability to fight the weak side. Since that is considered natural protocol to today's healing it's not what is being considered here. It IS what is being considered by Mr. Singer to be EXCLUDED from those humans decided against purely by their inability to conform to some impossible creation that he has tempting his own distorted mind. The trouble today is that science or the drugs discovered through what is natural is becoming the enemy to and distorter of nature. It's superceding what it was designed to help. Its idolatry is making what is natural and good into almost a condition of slavery to pharmaceutically designed objects. I like to make the comparison of the kind of "natural" death occuring in Mother Theresa's homes vs. machine run last hours without any human touch or personally selective compassion. Singer would no doubt condemn the entire population of those cared for by Mother's sisters (including the abandoned babies) as worthless, even where there is no question of extraordinary means keeping them alive. It's in the intention....and therefore in the heart!

[Lynn Gazis-Sax]

Singer is half right and the other half dead wrong, in his refusal to distinguish between failing to use extraordinary means to save someone and active killing. Half right, because in practice withholding treatment does shade into something that, for practical purposes, is the same as euthanasia, if the treatment you're withholding is easy, likely to be effective, and is being withheld precisely because you think the person's quality of life is so poor that it's really better not to preserve their life in this state.

But half dead wrong, because he appears to be arguing that the very idea of being allowed to refuse extraordinary means is bogus, and that refraining from a treatment that could save someone's life is entirely morally equivalent to actively killing someone. I've heard this line of argument a lot from proponents of assisted suicide or of euthanasia, and it amounts to saying that the only available moral choices are either to say that people are always obliged to pursue every treatment possible to extend their lives, however uncomfortable and unlikely of success, or else to praise going out with a gunshot at the top of your form, a la Hunter Thompson. And just about no one actually believes that every possible treatment is obligatory; everyone agrees that dying people may, at some point, reasonably choose to emphasize palliative treatment.

[Lynn Gazis-Sax]

To be fair, Singer does make the distinction between two groups of infants where treatment may be withdrawn, one consisting of "infants who would die soon after birth even if all existing medical resources were employed to prolong their lives," and one where the infants could actually survive for a long time under intensive care. But then he goes on to say that basically everyone, the Catholic Church included, agrees with him that some lives should be ended, and are merely differing about the means to do it. And in this he's way overreaching the level of agreement about "extraordinary means" that actually exists.

The other thing that bugs me in this op-ed is the argument that, well, people are going to do it anyway, so you may as well have rules for it. The thing is, what happened in the Netherlands wasn't just that people were practicing euthanasia anyway, and so it got legalized. What happened was that doctors were already helping people commit suicide, and people pretty much agreed with them, so that no one actually wanted to enforce the existing law, and so it was legalized. If you have a law that you're not enforcing, sooner or later you need to make up your mind whether you want to enforce the law or dump it. But that's not the same thing as saying that everything that people are doing anyway should be legalized and given its own protocol.

And what does the Groningen protocol actually do? There's a couple of very general guidelines, to the effect that the infants' prognosis needs to look pretty darn bad and not likely to turn around - but who would ever do a "mercy killing" who didn't think that? The real meat of the thing, it seems to me, is the attempt to regulate things by having enough people approve of the euthanasia - if one doctor approves, and some other doctor gives an independent second opinion, and the parents approve, and everything is public, then presumably it will all be kosher.

This, to my mind, undercuts Singer's whole argument. Because, OK, fine, you have a protocol that makes sure everything's public and you know why babies are being killed - by what possible reasoning should that make anyone happier who didn't want any infant euthanasia to begin with? All the protocol does is bring community standards to bear - why should it change the mind of anyone who wants the community standard to be no infant euthanasia at all?