History, Infanticide, and Imperiled Newborns One of the most prominent dilemmas in neonatal intensive care is whether, once the decision not to prolong life has been made, active killing of newborns should be permitted. Medical ethicists have sharply disagreed in their responses to this question. [1] Yet those commentators who contend that active killing of neonates is morally acceptable have presented a one-sided and reductionist view of the history of infanticide to support their position. This over-simplification of the historical record has resulted in unwarranted moral extrapolations and conclusions. Cultural and Moral Relativism Helga Kuhse and Peter Singer recognize that their proposal to "allow active as well as passive euthanasia to be carried out before acceptance of the child into the community" is, at least with respect to active euthanasia, controversial. They attribute resistance to their view to "the Western attitude to human life," particularly the doctrine of sanctity of life, which affirms that "the life of a new-born baby is as much deserving of protection as the life of any adult." Kuhse and Singer intend to challenge the belief that sanctity of life, and its related protection of neonatal life, is intrinsic to civilized society, and draw heavily on cultural anthropology, which provides "a broader, less culturally-bound perspective on these problems." [2] Their attention turns to societies that permit the active killing of infants. For example, the Netsiliks, an Eskimo society that placed importance on having enough sons as hunters to ensure food for its members, practiced female infanticide because suckling a female infant for several years would prevent the mother from having a son. The !Kung of the Kalahari were a highly nomadic group that practiced infanticide because of the difficulty of providing food for children. Kuhse and Singer also discuss the Tikopia of Polynesia, a group in which the father could decide to kill a newborn at birth, a decision "typically motivated by a comparison between potential food supplies and family size." [3] To forestall criticism that the Netsilik, 'Kung, and Tikopia are "primitive uncivilized people, whose experiences are of no relevance to our own," Kuhse and Singer also examine practices in eighteenth and nineteenth century Japan, surely a "civilized" society by any measure. The Japanese practiced infanticide as the commonly accepted method of "thinning" (mabiki--a term taken from the peasant practice of thinning rice seedling) family size well into the nineteenth century. [4] Based on this evidence, the authors conclude that our Western conviction concerning the moral status of infants is "a deviant tradition." We differ from the majority of human societies in rejecting infanticide for purposes of sex selection, population control, and even ridding society of the burdens imposed by the handicapped. Several commentators follow Kuhse and Singer in relying on cultural anthropological data to support a permissive attitude to infanticide. Earl E. Shelp, for instance, observes that while infanticide "tends to be viewed with horror by people in so-called civilized societies," it has in fact been practiced widely. Shelp concedes that cultural anthropological data does not "help us to reach a moral judgment regarding [infanticide] in the past or proposals to accept some form of it in the present," but his own assessment is most lenient. [5] In fact, despite his concession, it is evident Shelp uses such data for precisely such a purpose. We are admonished that cultural and historical data can be studied to "discern what moral sensibilities exist within it," and that contemporary efforts to confer "absolute value" on newborn life appear to be "aberrations within the human and moral record." In addition, Shelp provides economic, physical, and sociocultural reasons for infanticide to mitigate moral disapproval. …