Killing costly babies is “reasonable” says noted bioethicist

Eugenics_posterIn the same week that thirty years ago a doctor advised the parents of Baby Doe to let him die because he had Down syndrome, a noted bioethicist said that some babies should instead be actively killed to save the rest of us money.

Peter Singer is a professor at Princeton University where he holds an endowed chair of bioethics. Singer was interviewed by Aaron Klein as part of a book tour promoting (ironically) Singer’s latest book on altruism. Klein asked Singer whether killing infants born with severe disabilities should be a matter of policy in order to save costs to the health care system. Singer’s full response:

I think if you had a health-care system in which governments were trying to say, “Look, there are some things that don’t provide enough benefits given the costs of those treatments. And if we didn’t do them we would be able to do a lot more good for other people who have better prospects,” then yes.

I think it would be reasonable for governments to say, “This treatment is not going to be provided on the national health service if it’s a country with a national health service. Or in the United States on Medicare or Medicade.”

And I think it will be reasonable for insurance companies also to say, “You know, we won’t insure you for this or we won’t insure you for this unless you are prepared to pay an extra premium, or perhaps they have a fund with lower premiums for people who don’t want to insure against that.”

Because I think most people, when they think about that, would say that’s quite reasonable. You know, I don’t want my health insurance premiums to be higher so that infants who can experience zero quality of life can have expensive treatments.

(emphasis added).

Singer has been making the argument literally for decades that infants born with disabilities should be candidates for “non-voluntary euthanasia.” So, his response should not be surprising to those who know his work.

But I would hope his conclusion is wrong.

I would hope that most people, when they think about killing children born with disabilities, would NOT say “that’s quite reasonable.”

Singer’s argument is similar to the one made in favor of the absurdly named “After-Birth Abortions.” I would hope that most people would have the same response as the one that Singer’s colleague at Princeton, Robert P. George, had to that argument for killing children:

That’s madness.

That is what I would hope most people’s response is to Singer’s position.

But even if most do think that way, that is likely not enough.

That is because policies like the one Singer advocates for don’t need to be established by a majority. Instead, healthcare cost-effectiveness decisions are typically made by an elite minority.

And, as much as killing newborns seems like madness to me (and hopefully to you), Singer’s view of what most would consider “reasonable” starts to gain more traction with many people when the newborn with a disability isn’t a newborn, but instead is not-yet-born.

Since the 1980’s, California has had a state-funded prenatal screening program. The state pays for those pregnant women who opt to have prenatal screening and diagnostic testing. In justifying the costs of paying for prenatal testing, the program tracks how many children with Down syndrome were identified and aborted as savings. You see, the state health care system is then spared the costs those children with Down syndrome would cost the state if they had been born and accessed California’s state healthcare system.

And, at this year’s American College of Medical Genetics & Genomics, a CEO for a noninvasive prenatal screening laboratory gave a presentation making this exact argument for why more women should be offered his company’s product.

Ken Song, CEO of Ariosa, the maker of Harmony, gave a presentation entitled:

“Prenatal Screening for Fetal Aneuploidy with Cell-Free DNA is Clinically Superior and Provides Cost Savings in the General Pregnancy Population: A Cost-Effectiveness Analysis.”

Breaking it down, the presentation explained how cell free DNA testing, like Harmony, is clinically superior to traditional screening tests, like the nuchal translucency combined test or the quad test, because cell free DNA testing identifies more children with Down syndrome prenatally. Tests like Harmony are cost-effective, according to Song’s presentation, because the total cost of expectant mothers accepting the Harmony test is less than the cost of the lives of children with Down syndrome if those children were to be born. Through offering more women Harmony, goes Song’s argument, more children with Down syndrome are identified prenatally, and then the cost of those lives are avoided by those children being aborted. This is cost-effectiveness.

Does this sound reasonable to you?

By Singer’s argument it should.

But I think it’s madness.

Related posts to the issues addressed here can be found here and here.

Update: Lawrence Carter-Long writing for the National Council on Disabilities has an insightful, alliterative, comprehensive, and compelling response to Prof. Singer which also applies generally to those in medicine and philosophy. Key ‘graphs:

People with disabilities have also frequently seen firsthand that medicine, not unlike philosophy, is more of an art than a fixed, immutable status quo, particularly when it comes to the imperfections of medical prognosticating. It is not uncommon for individuals with disabilities and parents of children with disabilities to receive fervently bleak, but inaccurate predictions by members of the medical professional about options, opportunities or potential.

* * *

This is not to suggest that most or even a substantial portion of medical projecting is erroneous, but rather that people with disabilities are aware of enough instances of dramatic mistakes that many have a healthy and appropriate degree of skepticism when it comes to medical predictions, particularly as it relates to assumptions about one’s quality of life.

Medical personnel are not always very knowledgeable of special education and rehabilitation techniques, specialized accommodations, independent living philosophy, and other factors that may spell the difference between a direly limited or satisfying and fulfilling future for an individual with a disability. And it seems, neither are some philosophers on media tours to sell their latest book.

I wholeheartedly agree with the NCD’s closing assignment to Prof. Singer and anyone else wishing to predict the future worth of those lives with disabilities:

“Professor, do your homework.”

(emphasis added). Read the whole thing at this link.

Comments

  1. Unfortunately, this is a very common argument and has been the cornerstone of universal prenatal screening for Down syndrome. It has only ever been about stopping our kids being born and saving money. I’ve written about it here http://www.savingdowns.com/how-much-is-your-child-worth/

    We are now seeing screening becoming normalized by society and the majority of Down syndrome advocacy, although the underlying assumptions and objectives remain. Ultimately this reinforces a cycle of prejudice against them.

  2. I am with you. This is madness. Remember the argument in Nazi Germany when they asked schoolchildren to calculate the cost of taking care of one disabled person, versus the cost of helping a newly married couple? This is exactly the same kind of cost-accounting. The policies enacted as a result of this thinking caused the economic collapse of Germany and resulted in decades of slavery to communism of half the country. Singer is refusing to learn the lessons of history, and he wants us doomed to repeat them. He should simply refuse to buy health insurance. The whole problem is health insurance, really. If people could choose plans for catastrophic events that would cover such contingencies as the birth of a disabled child, then the cost wouldn’t be that high. What drives up costs is all the people seeking reimbursement for ordinary medical expenses. We have been without health insurance for a couple of decades. We pay for our own medical care and supplements out of pocket, and it’s cheaper. We won’t face a lot of the same health problems because we take good care of our health and diet.

    I have a nephew with Down Syndrome. He is a precious human being. He brought healing to his family. He is priceless, and there is no way I would ever countenance his extermination to save costs. My sister refused prenatal testing because she wouldn’t get an abortion anyway. And you know what? Many of the costs of helping people with Down Syndrome are REALLY because we haven’t designed our educational system to meet their needs. If we did, they would develop much better, and the costs would go down. And it would help other children, too. My observation is that the Montessori Method works best, and it is excellent for all children. My nephew had the language development of a 5 year old when he was 3 1/2, because he was exposed to intensive opportunities to learn language. But the public school system failed him miserably, and nobody bothered to explain how to discipline a child with this type of disability, and this is definitely a difficult area for most parents, and needs to be addressed. It’s not their fault or their problem. It’s the system. Fix the system.

    • An interesting take on costs that I hadn’t seen made in this context. Thank you for suggesting a more macro & fundamental perspective.

      • You’re welcome. This came to mind as soon as I heard the modern argument. We have refused to learn the lessons of history. If we take the lives of people because they are disabled, there will be a steep price to pay that nobody is taking into consideration. And there are hidden blows to the economy as well. Germany’s economy collapsed. Part of that took place before Hitler’s reign, and was part of the reason he was chosen by the largest minority. But his policies only made things much worse. And in fact, the extermination efforts against the Jews wiped out civilized people, and these are being replaced by people whose religion is a holdover from the Middle Ages, and about as humane (not at all). This kind of cost-accounting is what led to this in the first place. As soon as a powerful human being decides you do not deserve to live, and has the means to carry out his assessment, we are in deep trouble.

        Each human life is infinitely precious. People don’t take this into account when they make such calculations. Even a human being who has a disability is still a being of infinite worth. We have a DUTY to find an answer for the disability, not to simply eliminate the person.

        I would much rather protect the life of an individual whose LOVE IQ is in the stratosphere (as is the case with people with Down Syndrome) than some highly intelligent tyrant. The tyrant causes a lot more damage, than the cost of caring for people with Down Syndrome.

        People with disabilities are our invitation to develop compassion. This trait is also priceless, and most of us would never develop it without the need.

  3. Who gives any one of us the right to decide who has quality of life or has better prospects? We’re all getting so selfish and thoughtless about other people, it’s a poor statement on humanity.

  4. Pete Gummere says:

    Utterly appalling! Singer continues to perpetrate the utilitarian view of the human person. He seems to negate the inherent dignity of the human person.

    • Singer recognizes no human dignity whatsoever. To him, we are just another animal. This is the fruit of the Theory of Evolution. If you recognize each of us as made in the image of God by His own act, it totally changes the outlook.

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