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them, therefore, cannot be equated with killing normal human |
beings, or any other self-conscious beings. This conclusion is |
not limited to infants who, because of irreversible intellectual |
disabilities, will never be rationaL self-conscious beings. We saw |
in our discussion of abortion that the potential of a fetus to |
become a rationaL self-conscious being cannot count against |
killing it at a stage when it lacks these characteristics -:- not, that |
is, unless we are also prepared to count the value of rational |
self-conscious life as a reason against contraception and celibacy. |
No infant - disabled or not - has as strong a claim to life |
as beings capable of seeing themselves as distinct entities, existing |
over time. |
The difference between killing disabled and normal infants |
lies not in any supposed right to life that the latter has and the |
former lacks, but in other considerations about killing. Most |
obviously there is the difference that often exists in the attitudes |
of the parents. The birth of a child is usually a happy event for |
the parents. They have, nowadays, often planned for the child. |
The mother has carried it for nine months. From birth, a natural |
affection begins to bind the parents to it. So one important |
reason why it is normally a terrible thing to kill an infant is the |
effect the killing will have on its parents. |
182 |
Taking Life: Humans |
It is different when the infant is born with a serious disability. |
Birth abnormalities vary, of course. Some are trivial and have |
little effect on the child or its parents; but others turn the normally |
joyful event of birth into a threat to the happiness of the |
parents, and any other children they may have. |
Parents may, with good reason, regret that a disabled child |
was ever born. In that event the effect that the death of the |
child will have on its parents can be a reason for, rather than |
against killing it. Some parents want even the most gravely |
disabled infant to live as long as possible, and this desire would |
then be a reason against killing the infant. But what if this is |
not the case? In the discussion that follows I shall assume that |
the parents do not want the disabled child to live. I shall also |
assume that the disability is so serious that - again in contrast |
to the situation of an unwanted but normal child today - there |
are no other couples keen to adopt the infant. This is a realistic |
assumption even in a society in which there is a long waitinglist |
of couples wishing to adopt normal babies. It is true that |
from time to time cases of infants who are severely disabled and |
are being allowed to die have reached the courts in a glare of |
publicity, and this has led to couples offering to adopt the child. |
Unfortunately such offers are the product of the highly publicised |
dramatic life-and-death situation, and do not extend to |
the less publicised but far more common situations in which |
parents feel themselves unable to look after a severely disabled |
child, and the child then languishes in an institution. |
Infants are sentient beings who are neither rational nor selfconscious. |
So if we turn to consider the infants in themselves, |
independently of the attitudes of their parents, since their species |
is not relevant to their moral status, the principles that govern |
the wrongness of killing non-human animals who are sentient |
but not rational or self-conscious must apply here too. As we |
saw, the most plausible arguments for attributing a right to life |
to a being apply only if there is some awareness of oneself as |
a being existing over time, or as a continuing mental self. Nor |
183 |
Practical Ethics |
can respect for autonomy apply where there is no capacity for |
autonomy. The remaining principles identified in Chapter 4 are |
utilitarian. Hence the quality of life that the infant can be expected |
to have is important. |
One relatively common birth disability is a faulty development |
of the spine known as spina bifida. Its prevalence varies in |
different countries, but it can affect as many as one in five |
hundred live births. In the more severe cases, the child will be |
permanently paralysed from the waist down and lack c?ntrol |
of bowels or bladder. Often excess fluid accumulates III the |
brain, a condition known as hydrocephalus, which can result |
in intellectual disabilities. Though some forms of treatment exist, |
if the child is badly affected at birth, the paralysis, incontinence, |
and intellectual disability cannot be overcome. |
Some doctors closely connected with children suffering from |
severe spina bifida believe that the lives of the worst affected |
children are so miserable that it is wrong to resort to surgery |
to keep them alive. Published descriptions of the lives of these |
children support the judgment that these worst affected children |
will have lives filled with pain and discomfort. They ne,ed repeated |
major surgery to prevent curvature of the spine, due to |
the paralysis, and to correct other abnormalities. Some children |
with spina bifida have had forty major operations before they |
reach their teenage years. |
When the life of an infant will be so miserable as not to be |
worth living, from the internal perspective of the being who |
will lead that life, both the 'prior existence' and the 'total' version |
of utilitarianism entail that, if there are no 'extrinsic' reasons |
for keeping the infant alive - like the feelings M the parents |
- it is better that the child should be helped to die without |
further suffering. A more difficult problem arises - and the convergence |
between the two views ends - when we consider |
disabilities that make the child's life prospects significantly less |
promising than those of a normal child, but not so bleak as to |
make the child's life not worth living. Haemophilia is probably |
184 |
Taking Life: Humans |
in this category. The haemophiliac lacks the element in normal |
blood that makes it clot and thus risks prolonged bleeding, |
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