Baby's medical case revisited

Twenty years ago today, a baby boy was born in Bloomington that changed the course of medical and ethical history. When details of the case became public, the controversy was so intense that everyone from Bloomington Hospital to the Oval office were talking about it.\nThe child was born at 8:19 p.m. on Good Friday, 1982, at Bloomington Hospital. But the baby had complications. He was born with a malformed esophagus which prevented food from reaching his stomach. \nDr. Walter Owens, the parents' obstetrician, had given the parents two courses of action that they could take: To immediately take the baby to Riley Children's Hospital in Indianapolis for surgery, which would most likely open the esophagus, or be left alone and eventually die. \nBut because the child was born with a malformed esophagus, there would most probably be other follow-up surgeries, Owens told the parents. The child also had an unknown severity of Down's Syndrome. \nBut other doctors disagreed with Owens. They believed Owens had no right to give the option of letting the baby die. \nThe mother and father, 31 and 34, were parents with two other children. They were left with a very emotional and difficult decision to make. They called upon their friends, family and clergy to help them in their decision. After half an hour of deliberation, the father emerged from the room and told the doctors they were going to leave the baby alone.\n"When I heard the decision, I was very careful not to be emotional about it, and I told them that they made a very wise and courageous decision," Owens, who has been retired since 1991, said. \nJeff Lyons, author of "Playing God in the Nursery" wrote about the issue. \n"On April 10th, Owens, in consultation with the parents, drew up the infant's treatment order. It stipulated: 'Hospital personnel might feed the child orally, but they should be advised that it is likely to result in choking and death; intravenous feedings are forbidden; the child should be kept as comfortable as possible and given sedation as needed.'"\nSome nurses and doctors were outraged by the parents' decision. The hospital had asked for the parents to take the baby home with them, and if they declined, to sign a statement leaving the hospital no responsibility over the death of the baby. \nThe hospital then asked for a judge to determine whether the parents had the legal right to this decision and to absolve the hospital from any potential liability. When parties make a decision that is irreversible, they sometimes look to a judicial consultation. \nSpecial Circuit Judge John Baker was called from his home to preside over the hearing at 10 p.m. the night before Easter. \n"We didn't have a formal court setting," said Baker, who is now on the Indiana Court of Appeals in Indianapolis. "We sat in a classroom at Bloomington Hospital and discussed the case. I remember that I still had ink dye on my hands from painting Easter eggs with my kids earlier that day." \nThe hearing began at 10:30 p.m. Saturday night, just over 24 hours after the baby's birth.\nBaker listened to both sides of the case which consisted of lawyers, doctors, a clergyman, and the parents. After the informal preceding, Baker left the room to make his decision. He ruled in favor of the parents. \n"What it came down to is that if there are two competing courses of medical treatments, whose choice is it, is it the government's or the parents'?" Baker said. \nBaker noted that there was no time to research the case and subject.\n"I had a lot of decisions to make that night," Baker said, "and in a situation like that we have do to what we can do."\nBaker declared the family would remain anonymous, and the child became known as Baby Doe. All parties left, and the decision was final. \n"I drove home under the impression that the child would pass away the next day," Baker said. \nBut the baby lived six days, much longer than anticipated. \nThe next day Prosecutor Barry Brown received phone calls from members of the community including doctors, lawyers and concerned citizens.\nBrown felt he had a case against the parents through the Child in Need of Services Act, which provides essential services to children whose parents deny them care. \n"I was not involved with the first hearing at the hospital," Brown, who has recently retired, said. "It came to my attention by citizens of the community, and I felt that it was the right action to take under the Indiana Constitution." \nThat Monday, Brown filed the case in Monroe County Circuit Court, with Baker presiding. He ruled that he did not believe that the child was in need of assistance. \n"This was what it came down to, I didn't believe that the child was in need of services," Baker said.\nBrown said he has a great amount of respect for Judge Baker's decision.\n"The hearing was impartial, professional and consistent with the code of ethics," he said. "I also have great admiration for Baker allowing us to appeal the case."\nAfter bypassing the Court of Appeals, the case went to the Indiana Supreme Court. Five days after the baby was born, the Court declined to order that the baby be fed.\nJames Bopp, General Council to the National Right to Life committee in Washington D.C., received a phone call from Bob and Shirley Wright, who have a child with Down's syndrome and were willing to adopt the baby. The next day Bopp filed a request in Baker's court asking to adopt the baby.\n"We requested that the child be considered abandoned because the baby was not receiving food and water," Bopp said. "Therefore Bob and Shirley should have temporary custody over the child, pending the adoption."\nBaker denied the request. Bopp would head to the federal courts the next day to appeal the decision. \nWhile these court precedings were in motion and public, human rights activists petitioned in Bloomington and outside the Indiana Supreme Court. \n"I remember the activists standing on the corner of the block across from the hospital carrying signs and coffins," Owens said. "The case was very emotional and personal for all parties involved. You need to understand that the Doe's were very kind people. This was a decision that they had to live with the rest of their life."\nThe human rights activism became more extreme. Mallor, Owens, and Baker, who all had wives and children, received daily death threats.\n"I guess that goes with the territory," Baker said.\nAll parties agreed this case was mauled into a political issue by human rights advocates. Brown said he tried to steer clear of any political involvement.\n"It was my constitutional obligation as the elected county prosecutor to take this case, but I would not allow myself to become a political instrument in this matter," Brown said. "This case wasn't a right to life issue, it was a right to continue living issue."\nBopp said he and many others believed that if the baby had not been born with Down's Syndrome, that all steps would have been taken to save this baby's life. \n"Everyone from The Washington Post to President Ronald Reagan disagreed with the decision," Bopp said.\nAs a law professor from IU was on his way to appeal the case to the U.S. Supreme Court in Washington D.C., the baby died at 10:01 p.m. \n"I woke up Friday morning and found out the baby had died," said Bopp, who was also on his his way to appeal Baker's decision, not allowing the baby to be adopted.\nIt was the end to a case and a battle between life and death. After emotional fatigue, Brown and the other parties involved found no reason to file any criminal lawsuits after the baby's death.\nThe Doe's gave birth to a healthy baby girl in April of the following year. \n"If I'm not mistaken the child has just finished high school, and the family has remained intact," Owens said.\nThe outcome of this horrific week of deliberations, protests, arguments and court rulings has made a significant impact on the medical community, Owens said. The Baby Doe case directly prompted most hospitals throughout the country to establish ethics committees, and later court rulings have stemmed directly from this case. \nOn May 18, 1982 the Reagan administration sent a letter to 6,800 hospitals that receive federal funding, warning that it is illegal for hospitals that receive medical funding to "withhold from a handicapped infant nutritional sustenance or medical or surgical treatment required to correct a life-threatening condition," according to the U.S. Department of Health and Human Services' Web site.\nNever before has a case addressed the same issue, Mallor said. This decision ruled by Baker sparked a huge public outcry for new legislation.\nBopp said if this situation had happened in present-day courts, there would be no doubt all action would have been taken to save the baby's life because of new state and federal laws that prohibit such acts. \nThe anniversary of Baby Doe's birth raises the same questions that were raised 20 years ago. What rights parents have concerning life and death decisions of their children? To what extent can the government intervene? \nLegislation spurned from the controversial case has answered some questions, but as medical innovations alter the landscape of medical practice, many of them remain.