Jen Gunter’s New York Times op-ed
about the death of her twenty-two-weeks and three day year old son sums up everything that is terrible and tragic about our current debate over what constitutes infanticide. On the surface, her story is just of the sort that I worried about being eclipsed in our wrangling over the bills in Vermont, Virginia and elsewhere. As she puts her objection to the current rhetorical environment, “stories like [hers] are being perverted for political gain” by the President and by Senator Sasse. To counteract such (ostensibly) politically-motivated distortions, Gunter recounts her own experience in some detail. Her heartbreaking story is especially acute given that Gunter is herself an obstretician and gynecologist. (Or was,
rather—she gave up obstretics because of the trauma she suffered.)
There’s no easy way to criticize such an intimate essay—but critical reflection is, I think, necessary. Gunter is right that the dispute over infanticide politicizes stories like her own, and she is right that the depiction of parents and doctors as ‘executioners’ distorts what is happening in such cases. (Whether we can escape such a possibility in arguing about euthanasia is a crucial question.) Yet the irony is that in attempting to resist this politicization, Gunter reinforces it: her narrative has a point, and that point extends beyond exonerating doctors and parents in situations like hers from being charged with “executing children at birth.” Her own situation, she forcefully asserts, is not one the government “should insert itself into.” She wants to preserve as much latitude for parents and doctors—but latitude for what? Certainly Gunter’s own situation. But if her case escapes being an instance of ‘neonatal euthanasia,’ it’s possible to imagine almost identical cases that would count.
Here are the central details of Gunter’s account: She was pregnant with triplets. Her water broke at twenty-two weeks and three days, she went to the hospital. After consulting with a neonatologist, she learned that the “survival rate for male triplets at 22 weeks and three days was less than 1 percent.” She waited to give her boys names, boys “who seemed destined to die at birth.” Twenty-four hours later, she spontaneously gave birth to one of the boys while in the bathroom. Aidan was cared for by a nurse, while she was sedated in hopes that she would not lose her other two boys. As she puts it in a caveat, “ultimately, my other two sons survived.” Gunter and her partner had “decided that invasive procedures, like intraveneous lines and a breathing tube in a one-pound body would be pointless medical care.” And then she writes: “And so, as we planned, Aidan died.” She had only a day or so prepare for his death.
There are, though, some interesting gaps in the narrative that may bear on the nature of the choice that Gunter and her partner made to decline further medical treatment. As she puts it in a fascinating caveat, her other two sons “ultimately” survived. Presumably, they continued to gestate. She does not say, however, how long they lived inside of the womb before they were delivered—and whether they, too, needed the kind of medical care that Aiden was given. I raise this only because whether they were born immediately after Aiden—and I presume it was a matter of a week or weeks—would raise questions about what kind of probability of ‘success’ for nourishment, hydration, and the like Gunter thinks must be in place for treatment to not be ‘futile.’ If a less than 1% chance means care is futile (though one might reasonably challenge this in a neonatal context, as I would), is a 5% chance? A 25% chance? How long her other sons continued to gestate would significantly affect that probability.
That worry aside, it is easy to see how situations like Gunter’s are likely to increase as more couples pursue in vitro
fertilization. The moral hazards that arise within premature birth in those
cases—which may have been Gunter’s, or not—are considerable. Rates of twinning in IVF are considerably higher
than in ordinary conception. If that happens, or if more than one embryo are transferred and implant, the dangers of pregnancy go up considerably as well. That means, however, that people who only originally intended to conceive only one
child will sometimes discover that they have multiple children. They may feel an aversion to selective abortion, because they don’t want to choose between individuals. But if premature labor happens, these same individuals will be responsible for making decisions about whether hydration, nutrition, and the like are ‘futile’ or not. In such a context, the temptation to rationalize declining care will be considerable, especially if we think it licit to terminate a life (and not just a pregnancy) because it risks imposing ‘undue burdens’ upon a women’s psychological or emotional health.
It is especially pertinent and troubling, I think, that Gunter blurs the distinction between her own narrative of the tragic death of her premature son and third-trimester abortions: “Pregnancy terminations,” she writes, “at or after 24 weeks of gestation, the time largely accepted as viability, are typically performed because of severe fetal abnormalities combined with maternal health problems.” Pregnancy terminations, note—which in the context of such bills includes the termination of the individual being gestated, which is not at all Gunter’s case. In fact, there’s nothing in Gunter’s account to suggest that any of the criteria she raises had any role to play in her own decision to decline treatment. If Gunter’s decision was licit—and it is probably impossible to conclude one way or the other on the basis of an op-ed—it was so only because of her reasons. Others who might decline treatment in related contexts might well do so for reasons that would, in effect, render the act euthanasia—an unjustified termination of an individual’s life.
It is just because of this ambiguity, and the likelihood of such situations increasing, that the government must be involved in delimiting policies that put pressures upon doctors to extend medical care to every infant who is born, regardless of whether they were conceived unintentionally or survived an intentional effort to terminate their life. Senator Sasse’s bill only enjoins medical care: it does not specify what that care must be, nor could it. It presumably allows for situations where a blanket and comfort is all that is offered. But it does so only by resetting the moral context in which those decisions are made, by heightening the level of self-scrutiny for all involved and ensuring that the attitudes and pressures at the heart of our throwaway culture do not allow us to effectively reduce those who are not dying to those who are, and thereby effectively denying them care which they are owed. Gunter’s op-ed demonstrates, if anything, that the need for such protections on infant life is more urgent than ever.