Legal aspects of withholding treatment from handicapped newborns: substantive issues

The controversy over nontreatment of handicapped newborns arises in a context of criminal and civil law, against which the current controversy has unfolded. This article examines the legal setting and background under traditional criminal and civil law concepts of nontreatment of handicapped newborns. It focuses on substantive principles of law, showing that nontreatment would be legally permitted when treatment could not be reasonably said to be in the interest of the patient involved, and that nontreatment could be considered criminal where treatment would serve patient interests. It then relates this analysis to procedural issues and the federal Baby Doe legislation and regulations that have recently emerged.     

The legal basis for ethical withholding and withdrawing of life-sustaining medical treatment in children

Withholding and withdrawing life-sustaining medical treatment are common in paediatric practice, especially in intensive care units. However, not all clinicians apparently adhere to principles in ethical guidelines or to the principles which are to be found in judgments from common law cases arising when doctors and parents dispute treatment. This article examines selected ethical guidelines and compares them to judgments in leading cases. The rationale to forgo treatment is usually the child's "best interests" in both clinical practice guidelines and legal cases but in the former "best interests" may remain ill defined. Although "best interests" must essentially pertain to the individual child, the interests of others are not irrelevant. In legal cases "best interests" of the child are defined in terms such as "burden versus benefit", "futility", "indignity", "intolerability", "prolonging death rather than saving life" and "quality of life". These or like terms should form the basis of ethical decisions in discussions with parents when contemplating withholding or withdrawing life-sustaining treatment.     

A critique of Callahan's utilitarian approach to resource allocation in health care

The rationale of this article is grounded in the liberal tradition. It places the individual at the center of concern, and attempts to fortify the individual's basic right to health care. Attention is focused on the writings of Daniel Callahan, arguing that his approach is too cold and detached, and that age should not serve as the decisive criterion. The criticism of his views on older patients and on patients in post-coma unawareness (PCU) stems from two different lines of reasoning: the medical and the moral-contractual. From the medical perspective, while age is an important variable in determining a patient's medical condition, there are other--no less important--factors that influence one's health. From the moral-contractual line of reasoning, liberal society should not desert its citizens at the time they need its help most. The age criterion is too simple, too general, too sweeping. It provides too convenient an answer to a tough and troubling question. Similarly, the argument with regard to PCU patients should be qualified, taking into account the age of the patient, the cause of the condition, and the length of time in state of unawareness.     

A critique of current child molester subcategories: a proposal for an alternative approach

This paper examines the utility of previous attempts to subcategorize child molesters. We argue that research based on these categorizations has resulted in confusion due to differences across studies concerning which offenders belong in each group. For example, there are no agreed-upon guidelines for identifying a child molester as an incest offender or as a ‘stranger’ offender. We examine research findings associated with previous attempts to subcategorize child molesters as well as the literature on modus operandi. From this, we conclude that current attempts to subcategorize child molesters are flawed. We propose that distinguishing child molesters according to new criteria – that is, whether or not they have been previously associated with their victim – should result in more productive research and provide a better guide for treatment and postdischarge supervision. In our terminology, nonaffiliative child molesters are those offenders who are truly strangers to their victims whereas affiliative child molesters are characterized by an established caregiving relationship with the child for some period prior to the offense. These men, unlike nonaffiliative offenders, engage in a protracted grooming process before offending. Finally, we outline research, treatment, and risk-management strategies relevant to each of our subcategories.