The mother of this baby was a black drug addict, who I think was homeless, and certainly had little to no social support. She rarely, if ever, visited. As we discussed what to do with the baby, one of my partners, to my surprise, said that he thought that one of the factors in our decision should be the baby's social status. The baby was, in effect, unwanted. That made it easier, said my partner, to let the baby die, easier than if the baby had loving, caring parents who really wanted the baby.
I was a bit flabbergasted by that remark. (I was also a bit puzzled, since that remark was out of character for my partner; he is a fine and empathetic neonatologist.) I thought that all babies had an inherent self worth, regardless of the parents' social standing. If we let social standing influence these decisions, the potential for discrimination was great. Would factors like race or gender influence our decisions, even though none of us thought we were racist or sexist? Would a family's income affect us? Would we think that babies with wealthier parents were more wanted?
Although I disagreed with my partner - and still do - he had a point, sadly, about the child being unwanted. This child, if she lived, would have almost certainly gone into foster care, where many of the babies bounce from home to home until they reach age 18 and are left to fend for themselves. Black babies born to drug addicted moms are not prime candidates for permanent adoption, and home life with her biologic mom was pretty much out of the question.
We ended up recommending to the mother that life support be removed. She agreed, we did so, and the baby died. I was on service, so the final call was mine, and I can assure you that we removed the ventilator because further treatment was futile, not because of the baby's social standing. The mother came in when her baby died and genuinely wept and grieved for her. Unplanned for with no place to go? Maybe. Unwanted? I don't think so.
P.S. A new Grand Rounds, version 2:31, is up at the Health Business Blog.
P.P.S. Check out the first edition of Pediatric Grand Rounds at Unintelligent Design.