Beneficence and Decision Making in the Treatment of Meningomyelocele

Dissertation, The Johns Hopkins University (1986)

Jon K. Borowicz
Milwaukee School of Engineering
Medical techniques now make it possible to keep alive many victims of meningomyelocele who formerly would have died. A number of physicians and others have said that it is permissible to withhold treatment when the infant, if kept alive, would suffer serious physical or mental impairment. They contend that for some infants it will be better to die than to survive severely impaired, and that this policy is permissible because it is beneficent, i.e., directed by the intention to bring about the patient's good. ;While initially plausible, this attempted justification of the policy raises philosophical problems that have not been treated adequately in the literature, and whose consideration reduces its plausibility. ;First, the permissibility of withholding life-preserving treatment from normal adults requires obtaining their informed consent. Because the defective infant is incapable of decision, and possesses no interests, the concept of proxy consent will not support the decision that his interests would be served by his death. Appealing to the infant's interests cannot succeed in rendering permissible any decision concerning treatment. ;Second, under the ordinary conception of beneficence, one cannot act beneficently toward another by bringing about his nonexistence. One who no longer exists is in no state at all, not in a state better than one of continued existence. The nonworthwhileness, negative value, and poorer quality of life presuppose that the life so judged be compared with another existing life. ;Third, a conception of beneficence more nearly adequate to the purpose of those who would withhold treatment can be derived from Thomas Nagel's notion of relational value, according to which good is indentified in terms of history and possibilities. While this notion permits us to explain the good and ill ascribed to the deaths of adults, it poses special problems for the evaluation of the lives of infants. ;I conclude that in the case of the birth defect, meningomyelocele, the policy of permitting the withholding of treatment cannot be shown to be beneficent on the ground that it leads to the good of the infants from whom treatment is withheld
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