unsuccessful efforts <strong>of</strong> a private attorney—promptedby a whistle blower—to obtain a court order forsurgery; and the unsuccessful efforts <strong>of</strong> the Department<strong>of</strong> Health and Human Services to gain accessto her medical records. 54 Finally, throughout thecontroversy, the accounts <strong>of</strong> the future predicted forher—should she survive—were unremittingly bleak.The director <strong>of</strong> the American Academy <strong>of</strong> Pediatrics,Dr. Harry Jennison, said, "'Baby JaneDoe'. . .not only has spina bifida but fluid on thebrain and an abnormally small brain. The baby is soseverely deformed that there is nothing that can bedone." 55 A Los Angeles Times editorial noted,"Doctors say that without surgery the girl may liveup to two years; with it she could live until she is 20,but she would be severely retarded, epileptic andparalyzed from the waist down, as well as inconstant pain." 56The Washington Post quoted the court testimony<strong>of</strong> pediatric neurologist Dr. George Newman: "[O]nthe basis <strong>of</strong> the combination <strong>of</strong> malformations thatare present in this child, she is not likely to everachieve any meaningful interaction with her environment,nor ever achieve any interpersonal relationships.. . ."" Newman also testified, "It's unlikelythat she is going to develop any cognitiveskills" and would experience "nothing whatsoever"that he considered positive on the cognitive scale. 58The baby's parents described in an interview whatthey were told about the child's future by medicalpersonnel—the information on the basis <strong>of</strong> whichthey decided against surgery:"We were told. . .that the part <strong>of</strong> the brain that controlsmuch <strong>of</strong> our awareness was either missing or not entirelyformed.We are not talking about a spina bifida child,. . .onewho could perhaps walk someday with braces. . . .Shewill be an epileptic. Her condition for future life is to bebedridden, and she would not have use <strong>of</strong> her hands.54See chap. 5, text accompanying notes 25-32; and chap. 6, textaccompanying notes 89-107.55Pro and Con[] Should Uncle Sam Protect Handicapped Babies?U.S. News & World Report, Jan. 16, 1984, at 63, 64.56 Indecent Zealotry, Los Angeles Times, Nov. 16, 1983, pt. II, at6.57Barringer, Meese Approved Intervention in Baby Case, WashingtonPost, Nov. 16, 1983, at A16.»» Transcript at 47, 95-96, People ex rel Washburn v. StonyBrook Hosp., No. 83-19910 (N.Y. Sup. Ct. Oct. 19, 1983).59Quoted in J. Lyon, Playing God in the Nursery 51-52 (1985).80Caplan, Is It a Life? The Nation, Jan. 21, 1984, at 37, 37.We also know that as she grew older, she would alwaysbe an infant. She would never know love. And while shemight feel sorrow and joy, her overall condition would bepain." 59Asking "Is it a Life?" bioethicist Arthur Caplan(then on the staff <strong>of</strong> the prestigious Hastings Center)wrote <strong>of</strong> Baby Jane Doe, "No one should be forcedby the government, [or] civil libertarians. . .to livesuch a life, even briefly." 60Notwithstanding the legal efforts opposed toproviding medical treatment for Baby Jane Doe, sheis alive today. 61 Although the courts had upheld herparents' decision to withhold operations to install ashunt and to close her back, the parents had time tochange their minds. A shunt was installed, her backhealed, and she was taken home. 62 As she left thehospital, Dr. George Newman had not changed hisprognosis: "She will still be severely retarded and, Istill think, bedridden all the days <strong>of</strong> her life." 63When they took her home, her father commentedto a reporter, "We're happy because she appears tobe happy." 64 About a month later, a reporterdescribed her as "smiling and cooing as her motherfeeds her. . . .[S]he grasps a visitor's finger in a tinyfist. . . ," 65 Already she was using her "unusable"hands. In June 1986, when she was 2 years and 8months old:Her. . .father said [she] likes to throw a ball to thefamily's golden retriever, cruise around in a walker and tryto sing "Row, Row, Row Your Boat." He said he and hiswife decided initially against surgery because it appearedshe could die at any moment and they did not want to addto the baby's pain."All <strong>of</strong> a sudden it turned around," he said. "From thatmoment on, we really saw her sense <strong>of</strong> fighting and senseto live and we were full steam ahead with what had to bedone for her." 68In December 1987, when she was 4, a reporterwrote <strong>of</strong> her, "Keri-Lynn talks and laughs; she61Baer, The Half-told Story <strong>of</strong> Baby Jane Doe, Col. JournalismRev., Nov.-Dec. 1984, at 35, 38.62Horan & Balch, Infant Doe and Baby Jane Doe: MedicalTreatment <strong>of</strong> the Handicapped Newborn, 52 Linacre Q. 45, 54(1985). Healing <strong>of</strong> the spinal lesion is rare without surgery but notwithout precedent.83Quoted in Lyon, supra note 59 at 55.84 Baby Jane Doe Goes Home, Milwaukee J., Apr. 6,1984, pt. 2, at3, col. 1.•* 'Adorable' Baby Jane Doe Finally Is Home, MilwaukeeSentinel, May 25, 1984, pt. 1, at 8, col. 1.66Associated Press, "Baby Doe" Parents Applaud Supreme CourtRuling, Domestic News PM Cycle, June 10, 1986.40
smiles and hugs and screams and plants kisses firmlyon a stranger's cheek." 67 She was using a wheelchairand attending school. 68 "I'm thrilled as canbe," her father said. "The fact that she's able torelate to us and her environment is amazing. Hermental awareness is fabulous now." 69 She was"learning to mix with her peers." 70 Of course, shestill has spina bifida. She does not walk, and requiresfrequent catheterization; she has had to have surgeryfor a dislocated hip. 71 But, in the followingdescription <strong>of</strong> Baby Jane Doe at 4, it is hard torecognize the pain-wracked, unaware, bedriddencreature <strong>of</strong> her doctors' confident predictions:She has recently begun to demand more than her shareand <strong>of</strong>ten resorts to throwing toys or M&Ms when thefocus shifts away from her. Then she whispers, "I'm bad,"aware that her mother is displeased with her behavior.. . .Later, she whispered, "Dance, Daddy, dance," asher father swept her into his arms to sway to the music <strong>of</strong>Stevie Wonder. 72A woman who works in parent support inPhoenix, Arizona, told the Commission about asimilar story:We also have our own little Baby Doe in Arizona andher name is Jessie. . Jessie was supposed to die the firstnight that she was born. She also had spina bifida,hydrocephalus, lots <strong>of</strong> severe brain damage, and all <strong>of</strong>those things that were not compatible with life, so notreatment was done for Baby Jessie. Days and days anddays went on and Baby Jessie fooled everybody and didnot die.Finally about the 21st day, right at the time the signswere hanging up in the nurseries, somebody got realnervous and said, maybe she's not going to die, maybe webetter do surgery. So by this time, unfortunately it wasreally too late to do much repair on her back, but they didput a shunt in and that little girl now talks in sentences andgoes to regular preschool.Her family really believed what the doctors said: Shewill die. So they just waited for her to die. And so for me87Kerr, Baby Doe's Success[S\ Progress Defying Prognosis, Newsday,Dec. 7, 1987, at 2.68Kerr, Baby Doe's Success\:] Legal, Medical Legacy <strong>of</strong> Case,Newsday, Dec. 7, 1987, at 2, 23.69Kerr, Baby Doe's Success[S\ Progress Defying Prognosis, Newsday,Dec. 7, 1987, at 2, 23.70Kerr, Baby Doe's Success[f] Legal, Medical Legacy <strong>of</strong> Case,Newsday, Dec. 7, 1987, at 2, 23.71Kerr, Baby Doe's Success[S\ Progress Defying Prognosis, Newsday,Dec. 7, 1987, at 2, 23.72Id.73Protection <strong>of</strong> Handicapped Newborns: Hearing Before the UnitedStates Commission on Civil Rights 264-65 (1986) (vol. II) (testimony<strong>of</strong> Betsy Trombino).as a parent I have a real difficult time with someonemaking that kind <strong>of</strong> a prognosis for a child and not doingany treatment. Because I have seen too many kids whodefy all the prognoses made for them. 73One family in the Chicago area can give twoexamples <strong>of</strong> negative predictions disproved. Theyare the adoptive parents <strong>of</strong> a child with spina bifidaleft to die in Robinson, Illinois, until the JusticeDepartment intervened. 74 When he was a year old,the Chicago Tribune reported that his adoptiveparents "believe that his alertness proves there hasbeen no brain damage and that his paralysis from theknees down won't keep him from walking." 75 Theirother example is their child born a few years earlier:"When she was 4 months old, the doctor told us she hadsome kind <strong>of</strong> neurological impairment—they still don'tknow exactly what. They advised us to put her in aninstitution and forget about her," said the mother.The child is now an alert, active 5-year-old who movesnormally around the house, and speaks many words, withonly slight hesitation. 76Patricia McGill Smith, deputy director <strong>of</strong> theNational Information Center for Handicapped Childrenand Youth, told the Commission about a case inOmaha, Nebraska. A child was born with spinabifida, and there was "a recommendation <strong>of</strong> notreatment based on the fact that the child had spinabifida and predictable mental retardation." After 4months <strong>of</strong> debate, the parents changed their initialdecision to accept that recommendation, and thechild received treatment and lived. Ms. Smithtestified, "I have tracked the progress <strong>of</strong> that childand that family ever since. The young lady had nomental retardation whatsoever." 77Such positive results for children born with spinabifida are not anomalous. Dr. David McLone, whoheads a major neurosurgical department and formerlychaired the Pr<strong>of</strong>essional Advisory Council <strong>of</strong> theSpina Bifida Association <strong>of</strong> America, testified:74Telephone interview with Robert D'Agostino, Former DeputyAssistant Attorney General, Civil Rights Division, Department<strong>of</strong> Justice (Dec. 1, 1988).75Nelson, 2d miracle baby gives family joy, Chicago Tribune, Apr.24. 1983, Sec. 3, at 1, col. 1.76Id.77Protection <strong>of</strong> Handicapped Newborns: Hearing Before the UnitedStates Commission on Civil Rights 254-55 (1986) (vol. II) (testimony<strong>of</strong> Patricia McGill Smith, Deputy Director, National InformationCenter for Handicapped Children and Youth).41
- Page 1 and 2: MedicalDiscriminationAgainstChildre
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(as opposed to the far) future, the
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It was recognized, therefore, that
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als with the particular disability
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cared for. They are thus different,
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medical advice. Given the magnitude
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tions at all regarding the subject
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strates that there is a grave dange
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Disincentives to Whistle BlowingDen
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Using a cumulative scaling procedur
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Of that 300 we targeted, approximat
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Conclusionphysicians set forth in t
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taking place when a report of suspe
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where the parents say "the child fe
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Nevertheless, the organization oppo
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Chapter 11The Role and Performance
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a member of the American Academy of
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possibilities that "will be most li
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clearly indicate that the committee
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Reviewing the first 30 months of th
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Webster's defines "suspected" as "t
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Chapter 12The Performance of the Fe
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The baby's doctor, E. Laurence Hode
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to achieve a reasonable life". . .w
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an unmarried mother receiving welfa
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can be sure all appropriate actions
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inquiries to determine whether they
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Chapter 13The Protection and Advoca
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authority to conduct retrospective
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facility that uses such a committee
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Chapter 14Findings and Recommendati
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as the coordination and development
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in the advisory process who is conc
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A Dissenting View on the Report Med
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arts) to depend upon knowledge of h
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Attachments to Statement of William
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medical facility. Considerations su
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Fund for the Improvement of Postsec
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eports such as Kopelman et al. demo
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Appendix 1EXPOSING OUR CHILDREN, EX
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abilities or functions, they are de
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My principal reason for objecting t
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I derive this hint from the many co
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moral distinction. A girl is a huma
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Appendix 2SURVEY OFSTATE BABY DOE P
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insure the immediate referral of po
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Hospital Liaisons Designated in Mos
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BABY DOE COMPARED WITH REGULAR CPS
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We also asked state CPS offices wha
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Limited information was available o
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one-quarter felt that baby doe case
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Appendix 3INFANT CARE REVIEW COMMIT
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and guidelines concerning the withh
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treated to assure the prompt ^repor
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3. Educating Staff and FamiliesThre
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One of the 10 ethics committees vis
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asphyxiation during the birth proce
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Prospective Review -- Each committe
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OBSERVATIONSThe inspection found th
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May 1, 1989Page 2The Commission adv
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Doe 1 admitted on the record of the
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tion is the basis for failure to tr
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her (much appreciated) vote for thi