When to Save the Baby: The Fundamental Conditions Approach
Friday, October 13, 2023
8:00 AM – 9:15 AM ET
Location: Bristol (Third Floor)
The complexity of medical decision-making in critically-ill newborns requires an approach that avoids rigidity, acknowledges the ambiguity of quality of life determinations, and captures the possibility that life’s meaning is not limited to ratios of pleasure and pain. Drawing on Matthew Liao’s Fundamental Conditions Approach (FCA) to human rights, we propose using the FCA to help us navigate these difficult decisions. The FCA posits that a good human life is one spent pursuing certain basic activities such as deep personal relationships and knowledge, and the fundamental capacities are those capacities that one qua human being needs to pursue the basic activities. We will argue that in the context of medical decision-making at the beginning of life, the FCA implies that, other things being equal, it is more permissible to withdraw life support from an infant if 1) the infant lacks nearly all the fundamental capacities and 2) medical care cannot restore most of these fundamental capacities. To illustrate the FCA’s use in a real medical case, we apply it to the recent case of Tinslee Lewis, an infant born prematurely with a diagnosis of Ebstein’s anomaly and pulmonary atresia. We also compare the FCA to several competing approaches to medical decision-making in critically-ill newborns and consider multiple objections to our proposal. We conclude by pointing out that the FCA, which prioritizes fundamental capacities instead of often biased and value-laden assessments of quality of life, presents a preferable model for determining the appropriate course of action when treating sick newborns.
Matthew Liao, PhD – Director of the Center for Bioethics, School of Global Public Health, New York University; Jordan Liebman, BA,MA – Medical Student, School of Medicine, New York University