The Case of Baby Theresa

By Charles Krauthammer
April 3, 1992

The frontier of medical ethics is a busy

place. The heaviest activity these days is
near the territory marked "the killing of
innocents." Last year Washington state
came very close to passing a referendum to
legalize euthanasia. Derek Humphrey's
how-to suicide manual topped the bestseller
list. Society is growing increasingly tolerant
of the idea of cutting off the life of people
who have had enough.

Generally speaking, the moral pioneers

seek to kill the innocent (the terminally ill, for example) for their own good. Last week, however,
there was a further advance: An attempt was made to deliberately shorten one innocent life not for
its own good but for that of another.

The case was that of Baby Theresa, born anencephalic, that is, without a cerebral cortex, the major
thinking part of the brain. Having only a brain stem, which can support such basic functions as
respiration, Baby Theresa was born alive but doomed to very rapid death. (Ninety-five percent of
anencephalics die within a week.)

Anencephaly can be diagnosed in utero. Most parents abort. Theresa's parents, however, decided
to make something good of their tragedy. Theresa's mother decided not only to carry her to term
but to have her by Caesarean section so as better to preserve the baby's organs for immediate
transplant to other babies who need hearts, livers, kidneys and corneas.

But there was one problem. If the family waited for Baby Theresa to die of natural causes, the
dying process would likely so damage Theresa's organs as to make them unfit for transplant. The
parents therefore asked the courts to declare their baby dead at birth so that her organs could be
removed. The courts refused. Nine days after birth, Theresa died. By then, as her parents had
feared, her organs were dead too.

And yet the courts were right. Removing Theresa's organs would have amounted to harvesting the
organs of a living human being. At birth Theresa was very much alive. True, she was going to die
very shortly, but so are the elderly terminally ill. So are condemned prisoners. We don't arbitrarily
redefine these still living people as "dead" so as to harvest their organs.

But perhaps, lacking a brain, Theresa was not really a human being -- and thus not entitled to the
protections accorded human beings -- in the first place. Dr. Robert J. Levine, Yale professor of
medical ethics, told the New York Times that an anencephalic "has more in common with a fish
than a person." One is tempted to say that Dr. Levine has more in common with a lummox than an
ethicist. Modern neonatal research, points out Dr. D. Alan Shewmon of UCLA, should make us
"open-minded about the possibility that the subjective experiences of anencephalic infants, like
their external behaviors, may resemble more those of normal newborns" than adults in "persistent
vegetative states." It is quite possible that Baby Theresa's brain stem is taking over some of the
functions of a newborn's cortex and thus endowing her with some rudimentary "experience."

The New York Times misinformed its readers on Sunday that anencephalics "probably do not
experience anything, even pain." Shewmon can find no "logical or physiological basis for the claim
of some that an anencephalic infant can neither feel nor experience pain 'by definition.' " Even
thinkers like Robert Truog and John Fletcher, who favor redefining death to include anencephalics,
concede that whether anencephalics "perceive pain is fundamentally unknowable."

It is tragic that one cannot use the organs of a hopelessly doomed anencephalic to save the lives of
other infants. But to kill one innocent for the sake of another is simple barbarism. Even just
shortening a doomed life in order to lengthen another is a fateful start on that road.

And it will not stop there. The anencephalic is the frontier case, and the frontier is always moving.
Next comes the irreversibly comatose adult, organ farming with Nancy Cruzan. Then come the
Alzheimer's patients. Why not bring some good out of their tragedy too?

Beware of doing good. Indeed, the best news about the Theresa case is that the impulse to do good
was far less this time around than five years ago, when a similar case created much more popular,
scientific, even political sentiment to redefine death so as to not waste the organs of anencephalics.

Why the change? Because since then the pragmatists have lined up on the side of the angels.
Transplant doctors who would otherwise like to use anencephalic organs realize the great political
danger of pushing for the organs of a live baby. They know that ordinary citizens already harbor
the fear that somebody will take out their kidneys and lungs before they are really dead. Why
jeopardize public tolerance of the whole transplant enterprise for the organs of just a few babies a
year?

The only people left campaigning for these kinds of donations are the parents of anencephalics.
Theresa's parents were desperate to extract some meaning from their tragedy. Perhaps they should
console themselves with this: By manning the line between life and death, by representing the
inviolability of the human person -- even the most doomed, least "human" among us -- Baby
Theresa lived a life of brief but indispensable purpose.

Direction: After reading this case, on your own opinion, answer all the following questions.
Short Bond paper, TNR 12
1. How do we put a value on human life?
In an ideal scenario, there would be no financial motive to support human life. Maybe no
life has any financial motivation at all. When a person's potential death can contribute to
the life of another person, the value of their everyday existence is multiplied tenfold. When
it is discussed from a prejudiced perspective, the subject of human life becomes
complicated. In the event that the goal is accomplished and the value of life is recognized,
be assured that there is no goodwill toward the embryo when it is terminated too soon.
2. What should one do when there is a conflict between the law and one's own moral position
about an issue?

All people should have equity under the law. In the event that the law neglects to do as
such, at that point it isn't useful for its motivation. In a few instances, legal experts and
legal executives didn't maintain it to ensure that they could proceed in accordance with
their sense of ethical propriety. Maintaining the law may seem preferable, but most of the
time people choose to act honorably over optimally. Similarly, if one's ethical perspective
doesn't harm any innocent people, it should be exempt from the laws that apply to everyone
else.
3. If you were in a position to make the final decision in this case, what would it be and why?

In the event that I were in a situation to settle on an official choice for this occasion, at that
point I would have approved offering organs for move. Theresa's death might have come
sooner and at the same time, sparing the lives of other newborns, on the off chance that the
organs from the child Theresa were removed.