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Baby K (October 13, 1992—April 5, 1995) was an anencephalic baby who became the center of a major U.S. court case and a debate among bioethicists.

Contents

History

Stephanie Keene,[1] better known by the pseudonym Baby K, was born at Fairfax Hospital in Virginia, USA. At the time of her birth, she was missing most of her brain, including the cortex; all that remained was the brainstem, that portion of the brain responsible for autonomic and regulatory functions, such as the control of respiration, the heartbeat and blood pressure.[2] The baby's mother had been notified of her condition following an ultrasound,[1] but chose to carry the child to term because of "a firm Christian faith that all life should be protected".[3] She believed that God alone should decide how long the baby would live.[4] The hospital's viewpoint was that care provided to the baby would be futile.[3] The baby's mother wanted the hospital to continue with advanced supportive care (primarily ventilatory support), despite the fact that being born without a brain is not curable or treatable. [5] Fairfax Hospital doctors strongly advised a Do Not Resuscitate order for the child, which the mother refused. Baby K remained on ventilator support for 6 weeks while Fairfax searched for another hospital to which to transfer, but no other hospital was willing to accept Baby K. After the baby was weaned off constant ventilator support, the mother agreed to move the child to a nursing facility, but the baby returned to the hospital many times for respiratory problems.

When Baby K. was admitted to the hospital at six months of age for severe respiratory problems, the hospital filed a legal motion to appoint a guardian for the child's care and sought a court order that the hospital did not need to provide any services beyond palliative care. At trial, several experts testified that providing ventilator support to an anencephalic infant went beyond the accepted standard of medical care.[6] In contrast, the baby's mother argued her case on the grounds of religious freedom and the sanctity of life. In a controversial ruling, the United States District Court for the Eastern District of Virginia decided that the hospital caring for Baby K must put her on a mechanical ventilator whenever she had trouble breathing. The court interpreted the Emergency Medical Treatment and Active Labor Act (EMTALA) to require continued ventilation for the infant. The wording of this act requires that patients who present with a medical emergency must get "such treatment as may be required to stabilize the medical condition" before the patient is transferred to another facility. The court refused to take a moral or ethical position on the issue, insisting that it was only interpreting the laws as they existed. As a result of the decision, Baby K was kept alive much longer than most anencephalic babies.[3] It has been suggested by the dissenting judge in the case that the court should have used the condition anencephaly as the basis of the case, not the recurring subsidiary symptoms of respiratory distress. As the irreversibility of anencephaly is widely understood in the medical community, he argued that the decision to continue futile care only resulted in the repetitive diversion of medical equipment. [6]

Baby K died April 5, 1995 at Fairfax Hospital.[1]

Significance of Baby K. case

The case of Baby K. is of particular importance to the field of bioethics because of the rich variety of issues it raises: the definition of death, the nature of personhood, the concept of medical futility, and many issues relating to the allocation of scarce resources.

Some commentators, including Arthur Kohrman and Jacob Appel, have argued that the ruling effectively undermined the right of physicians to make sound medical decisions.

References

  1. ^ a b c "`Baby K' Dies at 2 1/2 in Fairfax Hospital". Richmond Times-Dispatch: p. B.6. 1995-04-07. http://proquest.umi.com/pqdweb?did=17976227&sid=4&Fmt=3&clientId=20886&RQT=309&VName=PQD. Retrieved 2009-05-25.   (Registration required)
  2. ^ Ruling in Virginia, The New York Times, Feb 12, 1994
  3. ^ a b c Greenhouse, Linda (1993-09-24). "Hospital Appeals Ruling on Treating Baby with Most of Brain Gone". The New York Times: p. A.10. http://proquest.umi.com/pqdweb?did=966574601&sid=2&Fmt=3&clientId=20886&RQT=309&VName=PQD. Retrieved 2009-05-25.   (Registration required)
  4. ^ Flannery, E. (1995) One advocate’s viewpoint: conflict and tensions in the Baby K case. Journal of Law, Medicine & Ethics, 23: 7-12
  5. ^ Greenhouse, Linda (1994-02-20). "Court Order to Treat Baby With Partial Brain Prompts Debate on Costs and Ethics". The New York Times: p. A.20. http://proquest.umi.com/pqdweb?did=967067481&sid=4&Fmt=3&clientId=20886&RQT=309&VName=PQD. Retrieved 2009-05-25.   (Registration required)
  6. ^ a b Matter of Baby K. 16 F.3d 590 (4th Cir. 1994)

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