Baby Doe Rules: In Reply

Abstract

ARTICLEIn Reply.— Thank you for this opportunity to clarify further why I believe that the American Academy of Pediatrics (AAP) should continue to advance individualized and compassionate decision-making for all children by promoting the best-interest standard and acknowledging the dangers of the so-called Baby Doe rules. They apply only to infants under 1 year of age and are found in the federal requirements for states that seek funds under the Child Abuse Prevention and Treatment Act.1 Requiring maximal treatment unless the infant is comatose or dying, these regulations were viewed immediately by neonatologists and other pediatricians as seeking to alter standards of care and as giving too little weight to infants' pain and suffering, parental consent, or clinical judgment.2,3 They single out infants for treatments that restrict the sort of choices adults want for themselves and that are recommended by the AAP.4–7 Unlike the Baby Doe rules, the best-interests standard permits families and physicians some latitude regarding what ought to be done even if the person is neither comatose nor dying. For example, some families (with the advice of clinicians) may choose comfort care for their incompetent and imperiled relatives, whereas others pursue every vanishingly small chance for survival. Joint decisions by families and clinicians about what is best for incompetent or incapacitated …