How does this practice differ from those of German doctors circa 1939–1945? Then, countless disabled babies were similarly neglected to death or killed based on doctors’ decisions as to which children had livable lives. Now, as then, a decision is made to take action, or rather, not to act, thus ensuring that the babies die. As before, the physicians believe they are providing a service to their soon-to-be-made-dead patients, the babies’ families, and society. (And this doesn’t include prenatal eugenic cleansing in which approximately 90 percent of fetuses testing positive for Down’s are aborted.62) Binding and Hoche would approve.
In response to the Baby Doe tragedy, the federal government passed regulations to prevent medical discrimination based on disabilities, which, unfortunately, were invalidated by courts. Congress then passed amendments to federal child abuse statutes as they affect the laws of the states to prevent medically beneficial treatments from being withheld due to quality of life criteria. The law permits the withholding of treatment for babies in irreversible comas if treatment would only prolong dying, if it would be virtually futile, and if it would be inhumane. Do these laws actually protect disabled infants? That is unclear. Former Surgeon General C. Everett Koop, who was instrumental in getting the Baby Doe laws enacted, has opined that they “are probably not legally effective” and that the “greatest protection that handicapped newborns have in the [United] States today is the concern on the part of physicians and surgeons who care for newborns that someone is watching.”63 Considering the increasingly utilitarian state of medical ethics and the pressures placed on doctors by managed care health insurance companies to cut the costs of health care, that protection may be scant indeed.
Active Infanticide: Most people know that it is wrong to kill babies. They view the intentional killing of medically incompetent people as murder. At least, they used to. As modern bioethics looms, that certainty comes under increasing attack.
In the 1970s, Joseph Fletcher, the patriarch of bioethics, advocated killing disabled children, an act he euphemistically called “post birth abortion,”64 dismissing the ethical and moral constraints against infanticide as a mere “taboo.” For Fletcher, the rightness of killing disabled babies could be determined through a simple utilitarian equation: If killing a baby increased happiness or reduced overall human suffering, than the baby should be made dead. If not, the baby should live. He wrote, “This view assigns value to human life rather than merely being alive and holds that it is better to be dead than to suffer too much or to endure too many deficits of human function.”65 (Emphasis in original.)
What was shocking in the 1970s is shocking no longer. Arguing in favor of infanticide is now respectable and mainstream. The Australian moral philosopher and Princeton bioethicist Peter Singer began arguing decades ago that infants have no moral right to live because, as discussed in the previous chapter, they are not “persons.” He views infanticide at the request of parents as an ethical act so long as it will promote the overall interests of family or society.
Singer originally suggested that parents have twenty-eight days within which to keep or kill their newborn child. He then broadened this putative license, telling an interviewer, “I no longer think that will work. It’s too arbitrary. I don’t think you would get people to recognize that there’s a big difference in the wrongfulness of killing a being at twenty-seven or twenty-nine days. So, what do you do? I think you need to look at it on a case-by-case basis given the seriousness of the problems and balance that against the age of the child.”66 Earlier in the interview, Singer supposed that a child became a person “sometime during the first year of life,” and thus his “case-by-case” approach could apply to murdering a baby for many months after the child is born.
When Singer’s views are discussed in the media, he is often portrayed as “only” calling for the infanticide of “severely disabled” babies. In and of itself, that would be terribly wrong, but this alleged mitigation simply isn’t true. Singer views all infants, not only disabled babies, as nonpersons who are “replaceable . . . in much the same way as . . . non-self conscious animals [e.g., bird and fish].”67 Since nonpersons have no right to life, so long as utilitarian principles are applied properly, there is nothing in his philosophy that explicitly limits infanticide to the killing of babies born with disabilities.
That being duly noted, Singer knows that it would not pay for him to discuss the killing of healthy babies, and so he almost always addresses the issue in connection with disabled infants. But even here the examples he gives of babies whom it should be ethically and legally permissible to murder are not “severely disabled.” In Practical Ethics, for example, Singer supported infanticide of newborns with hemophilia, writing: “When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of the happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if the killing of the hemophiliac infant has no adverse effect on others it would . . . be right to kill him.”68
Thus, to Singer, it is okay to kill a child for the benefit of hypothetical future siblings who have not yet been conceived!
Singer reiterated his anti-disability bias using a different type of disability as an illustration in Rethinking Life and Death: The Collapse of Our Traditional Ethics (1994, St. Martin’s Press, New York, NY), in which he wrote:
To have a child with Down syndrome is to have a very different experience from having a normal child. . . . (W)e may not want a child to start on life’s uncertain voyage if the prospects are clouded. When this can be known at a very early stage of the voyage we may be able to make a fresh start. . . . Instead of going forward and putting all our efforts into making the best of the situation, we can still say no, and start again from the beginning.69
Singer’s advocacy of infanticide (and for the morality of euthanizing profoundly cognitively disabled people as an ethical act) caused a tremendous uproar in Europe, particularly in Germany and Austria, countries with an acute memory of the euthanasia Holocaust. Indeed, so many Germans and Austrians despise Singer’s views that he is unable to lecture in those countries because of angry demonstrations that erupt against him whenever he appears to speak. These protests deeply disturb Singer. As a child of German/Austrian Jews who lost family members in the Holocaust, he resents his philosophy being linked in any way to the Nazis.
Singer defends himself by claiming that the acts he espouses are nothing like those of the German doctors who participated in infanticide, claiming that his proposals are merely predicated upon “avoiding pointless suffering.” But that was precisely what Binding and Hoche claimed when they labeled their proposal to kill disabled people a “healing process.” Singer also says that the German doctors’ motives in killing babies were different from the ones he espouses. That is not entirely true. As we saw, most German doctors who participated in killing believed fervently that they were benefiting all concerned: baby, family, and society. Singer attempts to distinguish himself further by claiming that he does not agree with racial hygiene theory. That much is true, but so what? A murdered baby is a murdered baby is a murdered baby, regardless of why the baby is killed. That Singer does not grasp that basic moral concept speaks volumes about his philosophy.
Another tack Singer takes to distance himself from the German experience is by claiming that “Nazi euthanasia was never voluntary.”70 Here, Singer is simply wrong.
The first known German government-approved infanticide, the killing of Baby Knauer, occurred in early 1939. The baby was blind and had a leg and an arm missing. Baby Knauer’s father was distraught at having a disabled child. So he wrote to Chancellor Hitler, requesting permission to have the infant “put to sleep.” Hitler had been receiving many such requests from German parents of disabled babies over several years and had been waiting for just the right opportunity to