Abstract

KIE: The public debate on care of gravely impaired newborns is seen as overly preoccupied with procedural issues as opposed to more substantive, though less clear-cut, moral considerations. In exploring whether there are morally significant differences between normal and handicapped infants that can justify differential treatment, the author analyzes the most compelling standard, that of the "best interests" of the child. He sees limitations in the standard, including problems of prognostic uncertainty, the unjust impact of socioeconomic factors on quality of life, and the potential for bias when normal adults determine the best interests of impaired children. He concludes that there is need for a supplementary standard, geared to the presence or absence of distinctly human capacities in the infant, which recognizes two equally fundamental but contradictory moral imperatives--to sustain life and to ameliorate suffering.