Responses and Dialogue Ethics and Drug Infants Michelle Oberman Introduction The tone as well as the substance of Drs. Jain and Thomasma's essay reflects the alternating senses of tragedy, frus- tration, anger, and sympathy evoked by cases involving newborns suffering the effects of intrauterine drug exposure. The authors tell the story of a child born prematurely and with multiple disabil- ities which apparently were caused by maternal substance abuse. An ethical dilemma arises when, after two weeks of treatment in the NICU, the baby's mother requests that her child be taken off the ventilator. The authors do not view the request as wholly inappropri- ate in light of the infant's prognosis. (The infant's problems included poor projected neurological status secondary to intractable seizures and severe brain damage, and chronic lung disease.) In fact, they agree to stop the antiseizure medication on day 16 of the child's life. Instead, they reject the request to ter- minate life support primarily because it is given by a mother whom they believe to be "morally incompetent" to assert such choices for her child. This essay is a testimony to the diffi- cult challenges facing healthcare provid- ers and ethicists as they struggle to resolve the dilemmas arising at the in- tersection of poverty, drugs, and health- care. Their assessment of the conflicts posed by this case, and their proposed resolution of these conflicts, demon- strates the extent to which emotions such as frustration, anger, and sympa- thy can impede clear thinking about such complex issues. This commentary will attempt to isolate the issues raised by this case, and will propose an alter- native analysis and course of action for similar cases, which unfortunately are becoming increasingly commonplace. A Brief History of Healthcare Decisionmaking for Severely Disabled Newborns Until the early 1980s, the only guiding principle in determining healthcare op- tions in. the treatment of severely dis- abled newborns was the "best interests" test. Treatment was to be rendered only to the extent that it was consistent with the child's best interests. The child's parents were allocated full responsibil- ity for making these determinations, unless they were proven incapable of doing so. 1 In 1982, the private nature of this de- cisionmaking process was called into question by two cases involving dis- abled newborns who, in accordance with their parents' wishes, were permit- ted to die. The "Baby Doe" cases, as they came to be called, generated a pub- lic outcry when healthcare providers who were disturbed by the failure to treat these infants notified abortion ac- tivists and government officials of this hidden form of "child abuse." 2 The Cambridge Quarterly of Healthcare Ethics (1997), 6, 235-239. Printed in the USA. Copyright © 1997 Cambridge University Press 0963-1801/97 $9.00 + .10 235