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Planned federal order to halt 'mercy killings' could have broad impact

By Curtis J. SitomerLegal correspondent of The Christian Science Monitor / March 14, 1983



Will the Reagan administration's soon-to-be-implemented federal regulations regarding the care and sustenance of severely handicapped infants halt so-called mercy killings? Or will these rules tend to inhibit hospital care and possibly even limit the rights of parents and families to accept or reject medical treatment for their children?

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Storm clouds are fast gathering over a government order scheduled to take effect March 22 and ostensibly aimed at hospitals and health-care facilities receiving federal funds. Among other things, it requires the posting of warning notices in maternity wards, indicating that ''discriminatory failure to feed and care for handicapped infants . . . is prohibited by federal law.'' Further it provides that a toll-free telephone hot line be listed so those who suspect violations can report their concerns.

The American Hospital Association calls these rules ''simplistic'' answers for a complex situation. Some nurses and health-care groups consider the regulations an affront to their integrity and a sharp slap on the wrist by the federal government. And civil-rights and religious freedom advocates - who so far have not openly challenged the Department of Health and Human Services (HHS) rules - are concerned that they could be broadly interpreted to affect parents' freedom of choice regarding medical care for their youngsters.They could promote further confusion in the already controversial and unresolved debate over ''life support'' systems for those deemed terminally ill.

These regulations will also receive a resounding rap from a presidential commission report, ''Deciding to Forgo Life-Sustaining Treatment.'' The report is scheduled for release March 21, the day before the HHS rule goes into effect.

The President's Commission on the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research will reportedly criticize the administration for using punitive measures - threatened prosecution and cutting off of federal funds - to solve what it says is a highly complicated and delicate problem.

''It's a heavy-handed approach. They could have done things in a collaborative way,'' says one close to the commission who asks not to be identified.

''Imagine how a prospective mother in a maternity ward will feel when she reads a notice on the wall which says, in effect, that the only thing that will keep them (doctors and nurses) from killing her baby is a federal regulation.''

Some critics of the regulation suggest it is, at least in part, politically motivated - perhaps an effort by the administration to appease ''right-to-lifers ,'' who so far have been largely unsuccessful in getting Congress and the courts to outlaw abortion.

The debate over infanticide became particularly heated last spring following the death of a severely retarded infant who was denied nourishment and health care at his parents' request. The Indiana Supreme Court approved that action. At the time the child passed away, several petitioners were asking the US Supreme Court to order that the six-day-old boy be kept on life-support systems.

This situation prompted strong pressures on the administration to take federal action. The present regulations are a result.

Last fall, US Surgeon General Everett Koop testified before a congressional subcommittee that parents should be required to take steps to save the lives of severely handicapped infants.

At that hearing, Raymond Duff, professor of pediatrics at Yale School of Medicine, said severely handicapped infants were sometimes allowed to die because ''rescuing would only result in unbearable suffering for the handicapped and their families.''

Most states have so-called child abuse legislation which requires physicians, hospitals, social workers, teachers, and others to report suspected cases of neglect. Some have reported, however, that this has opened the door to crank calls and invasion of privacy. This same concern exists regarding the hot-line telephone requirement in the new government order.