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The legal rights of the child
Volume 58 Number 4
with this condition had one source of comfort, even though it was bleak, for a condition he knew he could not help in any way. Nature had somehow provided to the Mongol a compensating abnormality in the form of a low resistance to infection. Few patients with Mongolism lived beyond infancy or early childhood. But today, with the use of modern techniques and the newer drugs, the life of the Mongol can often be saved, and he continues a vegetative existence, worthless to himself and a burden to his family and to society. Is the use of these "miracles of modern medical science" morally justified for patients with Mongolian idiocy ? Is interference with the processes of nature justified in this condition ? Then, to add to the problem, in the last few years came the brilliant development of cardiac surgery. Congenital cardiac lesions are a part of the picture of Mongolian idiocy. Should we or should we not advise operation for a child who has Mongolism with a cardiac lesion ? We have discussed this "ethical problem" brought on by the developments of medical science in recent years with a number of pediatricians. It is a perplexing problem. As might be expected, opinion is divided. There is one group with a decided "yes" answer and another with a decided "no." A third group believes in selective judgment. What has been most interesting has been
Editor's
column
605
the background , training, and interest of the men in e a c h category. Department heads who have reached their position through research and scientific interests and whose relationship to patients has been confined to the hospital, make up, to a large extent, the "pro" group, whereas those whose interests are rather in the humanitarian side of medicine, and who have had to face the devastating influence of a Mongolian idiot on family life, on normal siblings, and on marital relationships, chiefly comprise the "con" group. We have asked some of the "selective" group if they ever thought of their attitude as one of "playing God." I t is not a question that can be decided by a majority vote, as ethical problems are matters that everyone has to decide for himself. The decision will depend on the individual's background and interests, to a large extent. We are not taking sides editorially or propagandizing for a personally held viewpoint. O u r purpose is rather to point out that the pediatrician faces important problems and decisions in medicine that cannot be solved by medical science and research. My personal viewpoint, reached gradually as years of practice and experience lengthened, places me squarely in the "con" group. However, I am not critical of those who reach a different ethical viewpoint of the question discussed. BORDEN S. VEEDER~ M.D.
The legal rights of the child A R E C v. N T decision (Vasta versus Malaze) in the State Supreme Court of New York touched upon a matter of fundamental importance to pediatricians. A 3-year-old boy, who had been raised by foster parents since his fifth day of life, became the center of a court dispute when his natural mother sued to obtain his custody. The facts in the case were as follows:
The child was born out of wedlock to a 14-year-old girl. He was given, apparently by the maternal grandfather, to a childless couple who raised the child as their own, planning to adopt him. Three years later the natural mother who had since married sued to have the child returned to her. She claimed that her father, now deceased, had arranged for the transfer of the child against
606
Editor's column
her wishes. Testimony during the trial brought out that she had made n o attempt to see the child or to seek assistance in obtaining his return until shortly before the trial. Testimony also brought out that her marriage was a stormy one, and that she was recently separated from her husband. The attorney for the foster parents introduced psychiatric opinions during the trial which agreed that a removal from the home would be likely to have deleterious effects upon the child's future emotionai development. In his decision to leave the child with
April 1961
his foster parents Judge John Cone stressed the significance of the psychiatric testimony in emphasizing the adverse effects that such a separation would have upon t h e child. The significance of this precedent-shattering decision is that, /'or the first time, the law has recognized the right of the child to a proper home. Hitherto the rights of the parents to their child had been considered paramount, regardless of the deleterious effects on the child. By this decision Judge Cone declared, in effect, that under certain circumstances children have rights which transcend those of their parents. JAMES M. TOOLAN~ M.D.
with this condition had one source of comfort, even though it was bleak, for a condition he knew he could not help in any way. Nature had somehow provided to the Mongol a compensating abnormality in the form of a low resistance to infection. Few patients with Mongolism lived beyond infancy or early childhood. But today, with the use of modern techniques and the newer drugs, the life of the Mongol can often be saved, and he continues a vegetative existence, worthless to himself and a burden to his family and to society. Is the use of these "miracles of modern medical science" morally justified for patients with Mongolian idiocy ? Is interference with the processes of nature justified in this condition ? Then, to add to the problem, in the last few years came the brilliant development of cardiac surgery. Congenital cardiac lesions are a part of the picture of Mongolian idiocy. Should we or should we not advise operation for a child who has Mongolism with a cardiac lesion ? We have discussed this "ethical problem" brought on by the developments of medical science in recent years with a number of pediatricians. It is a perplexing problem. As might be expected, opinion is divided. There is one group with a decided "yes" answer and another with a decided "no." A third group believes in selective judgment. What has been most interesting has been
Editor's
column
605
the background , training, and interest of the men in e a c h category. Department heads who have reached their position through research and scientific interests and whose relationship to patients has been confined to the hospital, make up, to a large extent, the "pro" group, whereas those whose interests are rather in the humanitarian side of medicine, and who have had to face the devastating influence of a Mongolian idiot on family life, on normal siblings, and on marital relationships, chiefly comprise the "con" group. We have asked some of the "selective" group if they ever thought of their attitude as one of "playing God." I t is not a question that can be decided by a majority vote, as ethical problems are matters that everyone has to decide for himself. The decision will depend on the individual's background and interests, to a large extent. We are not taking sides editorially or propagandizing for a personally held viewpoint. O u r purpose is rather to point out that the pediatrician faces important problems and decisions in medicine that cannot be solved by medical science and research. My personal viewpoint, reached gradually as years of practice and experience lengthened, places me squarely in the "con" group. However, I am not critical of those who reach a different ethical viewpoint of the question discussed. BORDEN S. VEEDER~ M.D.
The legal rights of the child A R E C v. N T decision (Vasta versus Malaze) in the State Supreme Court of New York touched upon a matter of fundamental importance to pediatricians. A 3-year-old boy, who had been raised by foster parents since his fifth day of life, became the center of a court dispute when his natural mother sued to obtain his custody. The facts in the case were as follows:
The child was born out of wedlock to a 14-year-old girl. He was given, apparently by the maternal grandfather, to a childless couple who raised the child as their own, planning to adopt him. Three years later the natural mother who had since married sued to have the child returned to her. She claimed that her father, now deceased, had arranged for the transfer of the child against
606
Editor's column
her wishes. Testimony during the trial brought out that she had made n o attempt to see the child or to seek assistance in obtaining his return until shortly before the trial. Testimony also brought out that her marriage was a stormy one, and that she was recently separated from her husband. The attorney for the foster parents introduced psychiatric opinions during the trial which agreed that a removal from the home would be likely to have deleterious effects upon the child's future emotionai development. In his decision to leave the child with
April 1961
his foster parents Judge John Cone stressed the significance of the psychiatric testimony in emphasizing the adverse effects that such a separation would have upon t h e child. The significance of this precedent-shattering decision is that, /'or the first time, the law has recognized the right of the child to a proper home. Hitherto the rights of the parents to their child had been considered paramount, regardless of the deleterious effects on the child. By this decision Judge Cone declared, in effect, that under certain circumstances children have rights which transcend those of their parents. JAMES M. TOOLAN~ M.D.