Passive euthanasia of patients with Down's syndrome

It is common in the United States to withhold routine surgery and medical care from infants with Down's syndrome for the explicit purpose of hastening death. About two-thirds of pediatricians say they would accede to a parental request to withhold treatment of duodenal atresia in such a child. It is not surprising, therefore, that a newborn with Down's syndrome and a tracheoesophageal fistula was allowed to die without surgery earlier this year, despite appeals to the Indiana and the United States Supreme Courts. Those who oppose euthanasia of these children point out that Down's syndrome does not usually interfere with the experiences and social relationships that make life worth living. Affected children do not experience unusual pain or suffering, unless they are abandoned or neglected. The most common reason for tolerating these deaths seems to be a belief that parental interests should be paramount when these interests conflict with those of a retarded child. It is understandable that a physician would want to support parents who believe their well-being is threatened by the continued existence of a handicapped child. These attitudes, however common in practice, may not be supported by our laws and may be influenced by an insufficient knowledge of the facts. They rest, in part, on the false assumption that a family that accepts a child with Down's syndrome is likely to be adversely affected in the long run. The majority actually do well. The controversy surrounding these cases is part of the larger debate about withholding or withdrawing treatment from other incompetent patients. It is important not to conflate Down's syndrome with conditions of profound retardation, incompatible with social experiences. Parental discretion may be more appropriate in such cases.