Perinatal Hospice: A Response to Partial Birth Abortion for Infants with Congenital Defects

Issues in Law and Medicine

Volumn 13, Issue 2, 1997, Pages 125-143

  Calhoun, Byron C ^a   Reitman, James S ^b   Hoeldtke, Nathan J ^c  

^a MADIGAN ARMY MEDICAL CENTER   (United States)

^b Internal Medicine Service   (Germany)

^c TRIPLER ARMY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ABORTION; CHROMOSOME ABERRATION; CHROMOSOME DISORDER; DEATH AND EUTHANASIA; FEMALE; GENETICS; GENETICS AND REPRODUCTION; HOSPICE; HUMAN; LEGAL ASPECT; MEDICAL ETHICS; MENTAL STRESS; NEWBORN; PERSONAL AUTONOMY; PERSONHOOD; PREGNANCY; PREGNANT WOMAN; PROFESSIONAL PATIENT RELATIONSHIP; RELIGION; REVIEW; SOCIOECONOMICS; THEOLOGY; UNITED STATES;

DEATH AND EUTHANASIA; GENETICS AND REPRODUCTION; PROFESSIONAL PATIENT RELATIONSHIP;

ABORTION, EUGENIC; CHROMOSOME ABERRATIONS; CHROMOSOME DISORDERS; ETHICS, MEDICAL; FEMALE; HOSPICES; HUMANS; INFANT, NEWBORN; PERSONAL AUTONOMY; PERSONHOOD; PREGNANCY; PREGNANT WOMEN; RELIGION AND MEDICINE; STRESS, PSYCHOLOGICAL; THEOLOGY; UNITED STATES; VALUE OF LIFE;

EID: 0031229364     PISSN: 87568160     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (105)

1. See Diane M. Gianelli, Shock-Tactic Ads Target Late-Term Abortion Procedure, AM. MED. NEWS, July 5, 1993, at 3, 15-16 [hereinafter Gianelli, Ads Target Late-Term Abortion]; Diane M. Gianelli, Outlawing Abortion Method. Veto-Proof Majority in House Votes to Prohibit Late- Term Procedure, AM. MED. NEWS, Nov. 20, 1995, at 3, 27.
2. See Diane M. Gianelli, Shock-Tactic Ads Target Late-Term Abortion Procedure, AM. MED. NEWS, July 5, 1993, at 3, 15-16 [hereinafter Gianelli, Ads Target Late-Term Abortion]; Diane M. Gianelli, Outlawing Abortion Method. Veto-Proof Majority in House Votes to Prohibit Late-Term Procedure, AM. MED. NEWS, Nov. 20, 1995, at 3, 27.
3. Diane M. Gianelli, Medicine Adds to Debate on Late-Term Abortion: Abortion Rights Leader Urges End to 'Half truths', AM. MED. NEWS, Mar. 3, 1997, at 3, 28-29.
4. Testimony before the House Judiciary Committee referring to taped and transcribed interviews conducted by reporters from American Medical News with Martin Haskell, M.D. and James T. McMahon, M.D. (figures provided by Dr. Haskell, cited from direct transcripts of the interviews). Excerpts from these interviews can be found in Gianelli, Ads Target Late-Term Abortion, supra note 1.
5. Gianelli, supra note 2, at 28.
6. Id. On those rare occasions when pregnancy truly poses a threat to the mother's life at gestational ages when partial birth abortions are typically performed, immediate delivery of the fetus with vigorous supportive care would result in survival of many fetuses. See Edward J. Wolf et al., Do Survival and Morbidity of Very-Low-Birth-Weight Infants Vary According to the Primary Pregnancy Complication that Results in Preterm Delivery? 169 AM. J. OBSTETRICS & GYNECOLOGY 1233 (1993); Walter J. Morales & Thomas Talley, Premature Rupture of Membranes at < 25 Weeks: A Management Dilemma, 168 AM. J. OBSTETRICS & GYNECOLOGY 503 (1993).
7. Id. On those rare occasions when pregnancy truly poses a threat to the mother's life at gestational ages when partial birth abortions are typically performed, immediate delivery of the fetus with vigorous supportive care would result in survival of many fetuses. See Edward J. Wolf et al., Do Survival and Morbidity of Very-Low-Birth-Weight Infants Vary According to the Primary Pregnancy Complication that Results in Preterm Delivery? 169 AM. J. OBSTETRICS & GYNECOLOGY 1233 (1993); Walter J. Morales & Thomas Talley, Premature Rupture of Membranes at < 25 Weeks: A Management Dilemma, 168 AM. J. OBSTETRICS & GYNECOLOGY 503 (1993).
8. Gianelli, supra note 2, at 29. See also Diane M. Gianelli, Medicine Adds to Debate on Late Term Abortion: ACOG Draws Fire for Saying Procedure 'May' be Best Option for Some, AM. MED. NEWS, Mar. 3, 1997, at 3, 27-28 (documenting opposition to the procedure from a group of obstetricians within the American College of Obstetrics and Gynecology).
9. N. P. Kuleshov, Chromosome Anomalies of Infants Dying During the Perinatal Period and Premature Newborn, 31 HUM. GENETICS 151 (1976); Rhona Bauld et al., Chromosome Studies in Investigation of Stillbirths and Neonatal Deaths, 49 ARCHIVES DISEASE CHILDHOOD 782 (1974).
10. N. P. Kuleshov, Chromosome Anomalies of Infants Dying During the Perinatal Period and Premature Newborn, 31 HUM. GENETICS 151 (1976); Rhona Bauld et al., Chromosome Studies in Investigation of Stillbirths and Neonatal Deaths, 49 ARCHIVES DISEASE CHILDHOOD 782 (1974).
11. Bonnie J. Baty et al., Natural History of Trisomy 18 and Trisomy 13: I. Growth, Physical Assessment, Medical Histories, Survival, and Recurrence Risk. II. Psychomotor Development, 49 AM. J. MED. GENETICS 175-88, 189-94 (1994); Jonathan P. Wyllie et al., Natural History of Trisomy 13, 71 ARCHIVES DISEASE CHILDHOOD 343 (1994).
12. Bonnie J. Baty et al., Natural History of Trisomy 18 and Trisomy 13: I. Growth, Physical Assessment, Medical Histories, Survival, and Recurrence Risk. II. Psychomotor Development, 49 AM. J. MED. GENETICS 175-88, 189-94 (1994); Jonathan P. Wyllie et al., Natural History of Trisomy 13, 71 ARCHIVES DISEASE CHILDHOOD 343 (1994).
13. Joan Callahan, Ensuring a Stillborn: The Ethics of Fetal Lethal Injection in Late Abortion, 6 J. CLINICAL ETHICS 254 (1995).
14. Id. at 254, 258-60.
15. See James S. Reitman, The Structure and Unity of Ecclesiastes, 154 BIBLIOTHECA SACRA 297-319 (July-Sept. 1997).
16. See James S. Reitman, The Debate on Assisted Suicide - Redefining Morally Appropriate Care for People with Intractable Suffering, 11 ISSUES IN LAW & MED. 299 (1995) [hereinafter Reitman, Debate on Assisted Suicide]; James S. Reitman, The Dilemma of "Medical Futility": A "Wisdom Model" for Decisionmaking, 12 ISSUES IN LAW & MED. 231 (1996) [hereinafter Reitman, Dilemma of Medical Futility].
17. See James S. Reitman, The Debate on Assisted Suicide - Redefining Morally Appropriate Care for People with Intractable Suffering, 11 ISSUES IN LAW & MED. 299 (1995) [hereinafter Reitman, Debate on Assisted Suicide]; James S. Reitman, The Dilemma of "Medical Futility": A "Wisdom Model" for Decisionmaking, 12 ISSUES IN LAW & MED. 231 (1996) [hereinafter Reitman, Dilemma of Medical Futility].
18. Roe v. Wade, 410 U.S. 113, 155 (1973).
19. Planned Parenthood v. Casey, 505 U.S. 833 (1992).
20. See, e.g., JAY KATZ, THE SILENT WORLD OF DOCTOR AND PATIENT (1984).
21. This resulted in successive revisions to abortion jurisprudence in a line of cases beginning with Planned Parenthood v. Danforth, 428 U.S. 52 (1976) and continuing with Akron v. Akron Center for Reproductive Health, 462 U.S. 416 (1983); Planned Parenthood Ass'n of Kansas City Mo., Inc. v. Ashcroft, 462 U.S. 476 (1983); Webster v. Reproductive Health Services, 492 U.S. 490 (1989); and, ultimately, Casey, 505 U.S. 833 See also Bo Schambelan, Postscript, in ROE v. WADE: THE COMPLETE TEXT OF THE OFFICIAL U.S. SUPREME COURT DECISION 101-116 (1992).
22. This potential problem of privacy is addressed in the following citation from Casey: Though the woman has a right to choose to terminate or continue her pregnancy before viability, it does not at all follow that the State is prohibited from taking steps to ensure that this choice is thoughtful and informed. Even in the earliest stages of pregnancy, the State may enact rules and regulations designed to encourage her to know that there are philosophic and social arguments of great weight that can be brought to bear in favor of continuing the pregnancy to full term and that there are procedures and institutions to allow adoption of unwanted children as well as a certain degree of state assistance if the mother chooses to raise the child herself. Casey, 505 U.S. at 872 (emphasis added).
23. Charles H. Zeanah, Adaptation Following Perinatal Loss: A Critical Review, 28 J. AM. ACAD. CHILD ADOLESCENT PSYCHIATRY 467, 476 (1989) (lamenting "the lack of clarity and uniformity about what comprises disordered mourning, the generally small sample sizes in the relevant studies, the nonuniformity of variables examined as predictors, and the nonreporting of all of the variables found not to be predictive."). See also Charles H. Zeanah et al., Initial Adaptation in Mothers and Fathers Following Perinatal Loss, 16 INFANT MENTAL HEALTH J. 80 (1995).
24. Charles H. Zeanah, Adaptation Following Perinatal Loss: A Critical Review, 28 J. AM. ACAD. CHILD ADOLESCENT PSYCHIATRY 467, 476 (1989) (lamenting "the lack of clarity and uniformity about what comprises disordered mourning, the generally small sample sizes in the relevant studies, the nonuniformity of variables examined as predictors, and the nonreporting of all of the variables found not to be predictive."). See also Charles H. Zeanah et al., Initial Adaptation in Mothers and Fathers Following Perinatal Loss, 16 INFANT MENTAL HEALTH J. 80 (1995).
25. Charles H. Zeanah et al., Do Women Grieve After Terminating Pregnancies Because of Fetal Anomalies? A Controlled Investigation, 82 OBSTETRICS & GYNECOLOGY 270 (1993) ("[T]here are numerous problems with studies on this topic, including use of unvalidated measures and failure to include measures specific to pregnancy or infant loss. Further, most previous studies have been retrospective, with assessments at variable times following the loss, and none used a comparison group other than the patient herself or an unmatched group who did not experience loss." (citations omitted)).
26. G. Zolese & C.V.R. Blacker, The Psychological Complications of Therapeutic Abortion, 160 BRIT. J. PSYCHIATRY 742 (1992).
27. Id. at 747.
28. Zeanah, supra note 19. A previous uncontrolled study indicated that 77% of such women experienced an acute grief reaction and 46% remained symptomatic six months after termination; some required psychiatric support. See also J. Lloyd & K.M. Laurence, Sequelae and Support after Termination of Pregnancy for Fetal Malformation, 290 BRIT. MED. J. 907 (1985).
29. J.A.M. Hunfeld et al., Emotional Reactions in Women in Late Pregnancy (24 weeks or longer) Following the Ultrasound Diagnosis of a Severe or Lethal Fetal Malformation, 13 PRENATAL DIAGNOSIS 603, 609 (1993).
30. Zeanah, A Critical Review, supra note 18, at 476 (citations omitted).
31. See Ten Reisser, Personal Characteristics as Predictors of Post-Abortion Emotional Distress 24 (Dec. 1994) (M. thesis, California Lutheran University) ("One might reasonably assume that if a woman is aborting because of a suspected fetal anomaly, her post-abortion adjustment would be easier because she could rationalize the medical necessity of the procedure. Contrary to this line of thinking, the literature unanimously demonstrates that women who have had abortions for fetal malformation experience more severe psychological trauma than those who abort in general" (citations omitted)).
32. Chris Butler, Late Psychological Sequelae of Abortion: Questions from a Primary Care Perspective, 43 J. FAM. PRAC. 396, 398 (1996) (citations omitted)
33. Id. at 399.
34. This was still the overarching and determinative concern in the outcome. See Casey, 505 U.S. at 844 ("Liberty finds no refuge in a jurisprudence of doubt.").
35. Id. at 851.
36. See e.g., H. TRISTRAM ENGELHARDT JR., THE FOUNDATIONS OF BIOETHICS 239-87 (2d ed. 1996).
37. Id. at 42-45.
38. Id. at 239-87 (insisting that autonomous choice and the correlative duty of permissive respect for others, i.e., tolerance, are the only values that can muster consensus for a secular morality and should therefore predominate in all such decisions).
39. See Stanley Hauerwas, Not All Peace is Peace: Why Christians Cannot Make Peace with Engelhardt's Peace, in READING ENGELHARDT 17 (Brendan Minoque, ed., 1997). A fuller exposition of the flaws of empirical and philosophical pluralism is undertaken by D.A. CARSON, THE GAGGING OF GOD: CHRISTIANITY CONFRONTS PLURALISM (1996).
40. See Stanley Hauerwas, Not All Peace is Peace: Why Christians Cannot Make Peace with Engelhardt's Peace, in READING ENGELHARDT 17 (Brendan Minoque, ed., 1997). A fuller exposition of the flaws of empirical and philosophical pluralism is undertaken by D.A. CARSON, THE GAGGING OF GOD: CHRISTIANITY CONFRONTS PLURALISM (1996).
41. See Ecclesiastes 3:10-11 (New International Version, unless otherwise indicated) ("I have seen the burden God has laid on men. He has made everything beautiful in its time. He has also set eternity in the hearts of men; yet they cannot fathom what God has done from beginning to end").
42. Ecclesiastes 8:5b-8a (New King James).
43. Don Marquis, Why Abortion is Immoral, 86 J. PHIL. 183, 190 (1989).
44. W. at 192 (emphasis added).
45. See supra note 22.
46. The powerful influence of existential dread that can be associated with the loss of such a perceived future is explored by Reitman, Dilemma of Medical Futility, supra note 12, at 243-46.
47. Irving G. Leon, Pregnancy Termination Due to Fetal Anomaly: Clinical Considerations, 16 INFANT MENTAL HEALTH J. 112, 120 (1995).
48. Id. at 119 (emphasis added).
49. Id.
50. Id.
51. See TERI REISSER & PAUL REISSER, HELP FOR THE POST-ABORTION WOMAN 35-45 (1994).
52. Id.
53. Roe, 410 U.S. at 153.
54. Casey, 505 U.S. at 852.
55. Cf. Reitman, Debate on Assisted Suicide, supra note 12, at 308-9.
56. Ecclesiastes 4:1b-3.
57. Hauerwas' perception of the societal unease that attends the prospect of a mentally handicapped child applies equally well to the prenatal detection of any congenital anomaly: I suspect that at least part of the reason it seems so obvious that we ought to prevent retardation is the conviction that we ought to prevent suffering. No one should will that an animal should suffer gratuitously. No one should will that a child should endure an illness. No one should will that another person should suffer from hunger. No one should will that a child should be born retarded. That suffering should be avoided is a belief as deep as any we have. That someone born retarded suffers is obvious. Therefore if we believe we ought to prevent suffering, it seems we ought to prevent retardation. STANLEY HAUERWAS, SUFFERING PRESENCE: THEOLOGICAL REFLECTIONS ON MEDICINE, THE MENTALLY HANDICAPPED, AND THE CHURCH 164 (1986); Cf. MARTIN S. PERNICK, THE BLACK STORK: EUGENICS AND THE DEATH OF "DEFECTIVE" BABIES IN AMERICAN MEDICINE AND MOTION PICTURES SINCE 1915 (1996).
58. Hauerwas' perception of the societal unease that attends the prospect of a mentally handicapped child applies equally well to the prenatal detection of any congenital anomaly: I suspect that at least part of the reason it seems so obvious that we ought to prevent retardation is the conviction that we ought to prevent suffering. No one should will that an animal should suffer gratuitously. No one should will that a child should endure an illness. No one should will that another person should suffer from hunger. No one should will that a child should be born retarded. That suffering should be avoided is a belief as deep as any we have. That someone born retarded suffers is obvious. Therefore if we believe we ought to prevent suffering, it seems we ought to prevent retardation. STANLEY HAUERWAS, SUFFERING PRESENCE: THEOLOGICAL REFLECTIONS ON MEDICINE, THE MENTALLY HANDICAPPED, AND THE CHURCH 164 (1986); Cf. MARTIN S. PERNICK, THE BLACK STORK: EUGENICS AND THE DEATH OF "DEFECTIVE" BABIES IN AMERICAN MEDICINE AND MOTION PICTURES SINCE 1915 (1996).
59. Betty Ferrell et al., The Experience of Pain and Perceptions of Quality of Life: Validation of a Conceptual Model, 7 HOSPICE J. 9 (1991); Betty Ferrell et al., Family Factors Influencing Cancer Pain Management, 67 POSTGRADUATE MED. J. S-64 (Supp. 2 1991); L. J. Muzzin et al., The Experience of Cancer, 38 SOC. SCI. MED. 1201 (1994).
60. Betty Ferrell et al., The Experience of Pain and Perceptions of Quality of Life: Validation of a Conceptual Model, 7 HOSPICE J. 9 (1991); Betty Ferrell et al., Family Factors Influencing Cancer Pain Management, 67 POSTGRADUATE MED. J. S-64 (Supp. 2 1991); L. J. Muzzin et al., The Experience of Cancer, 38 SOC. SCI. MED. 1201 (1994).
61. Betty Ferrell et al., The Experience of Pain and Perceptions of Quality of Life: Validation of a Conceptual Model, 7 HOSPICE J. 9 (1991); Betty Ferrell et al., Family Factors Influencing Cancer Pain Management, 67 POSTGRADUATE MED. J. S-64 (Supp. 2 1991); L. J. Muzzin et al., The Experience of Cancer, 38 SOC. SCI. MED. 1201 (1994).
62. HAUERWAS, supra note 50, at 189-210. See also the relevant discussion of the subtle pitfalls of family decisionmaking surrounding the birth of handicapped infants in James Bopp, Jr. & Richard E. Coleson, A Critique of Family Members as Proxy Decisionmakers Without Legal Limits, 12 ISSUES IN LAW & MED. 133, 140-56 (1996).
63. See e.g., Callahan, supra note 9.
64. HAUERWAS, supra note 50, at 211-17; Bopp & Coleson, supra note 52.
65. See, e.g., Dena Davis, Genetic Dilemmas and the Child's Right to an Open Future, HASTINGS CENTER REP., Mar./Apr. 1997, at 7.
66. See e.g., Respect for Persons and Their Agency, in ON MORAL MEDICINE 273-304 (Stephen E. Lammers & Allen Verhey eds., 1987); ENGELHARDT, The Context of Health Care: Persons, Possessions, and States, in FOUNDATIONS OF BIOETHICS, supra note 30, at 135-54; P. Goube de Laforest, An International Workshop: Life Sciences and the Concept of Person - Impact of Individual Opinions on the Respect for Human Personhood, 12 ETHICS & MED. 10 (1996).
67. See e.g., Respect for Persons and Their Agency, in ON MORAL MEDICINE 273-304 (Stephen E. Lammers & Allen Verhey eds., 1987); ENGELHARDT, The Context of Health Care: Persons, Possessions, and States, in FOUNDATIONS OF BIOETHICS, supra note 30, at 135-54; P. Goube de Laforest, An International Workshop: Life Sciences and the Concept of Person - Impact of Individual Opinions on the Respect for Human Personhood, 12 ETHICS & MED. 10 (1996).
68. See e.g., Respect for Persons and Their Agency, in ON MORAL MEDICINE 273-304 (Stephen E. Lammers & Allen Verhey eds., 1987); ENGELHARDT, The Context of Health Care: Persons, Possessions, and States, in FOUNDATIONS OF BIOETHICS, supra note 30, at 135-54; P. Goube de Laforest, An International Workshop: Life Sciences and the Concept of Person - Impact of Individual Opinions on the Respect for Human Personhood, 12 ETHICS & MED. 10 (1996).
69. Brief Amicus Curiae of Certain Physicians, Professors, and Fellows of the American College of Obstetrics and Gynecology in Support of Appellees, Roe v. Wade, 410 U.S. 113 (1973) (No. 70-18).
70. Psalms 139:15-16.
71. See Genesis 4:9; 9:5-6; James 3:9.
72. Evidence for this conclusion can be adduced from Psalm 139, supra note 58; Jeremiah 1:5, Genesis 1:26-27; Luke 1:39-44 (citing the in utero reaction of John the Baptist to the voice of Mary, the mother of the preborn Christ).
73. Exodus 4:11. See also John 9:3 (Specific biblical instances of such divine prerogative include the case of the man born blind "so that the work of God might be displayed in his life").
74. Ecclesiastes 11:5.
75. See Ecclesiastes 6:12 ("For who knows what is good for a man in life, during the few and meaningless days he passes through like a shadow? Who can tell him what will happen...?"). See also Bethany Spielman, Certainty and Agnosticism about Lethal Injection in Late Abortion, 6 J. CLINICAL ETHICS 270 (1995).
76. See supra notes 35-37 and accompanying text.
77. This assertion is the moral foundation of Exodus 21:22-25. While scholars have tried to prove that the "life for life" provision specified in this passage applies only to the mother and not the fetus (see, e.g., Robert N. Congdon, Exodus 21:22-25 and the Abortion Debate, 146 BIBLIOTHECA SACRA 132 (1989)), the most cogent and exegetically consistent understanding is that the death in view is of either the mother or the fetus. See, e.g., JOHN S. FEINBERG & PAUL D. FEINBERG, ETHICS FOR A BRAVE NEW WORLD 63-65 (1993).
78. This assertion is the moral foundation of Exodus 21:22-25. While scholars have tried to prove that the "life for life" provision specified in this passage applies only to the mother and not the fetus (see, e.g., Robert N. Congdon, Exodus 21:22-25 and the Abortion Debate, 146 BIBLIOTHECA SACRA 132 (1989)), the most cogent and exegetically consistent understanding is that the death in view is of either the mother or the fetus. See, e.g., JOHN S. FEINBERG & PAUL D. FEINBERG, ETHICS FOR A BRAVE NEW WORLD 63-65 (1993).
79. Victoria A. Vincent et al., Pregnancy Termination Because of Chromosomal Abnormalities: A Study of 26,950 Amniocenteses in the Southeast, 84 S. MED. J. 1210 (1991); Marlon S. Verp et al., Parental Decision Following Prenatal Diagnosis of Fetal Chromosome Abnormality, 29 AM. J. MED. GENETICS 613 (1988); Arie Drugan et al., Determinants of Parental Decisions to Abort for Chromosome Abnormalities, 10 PRENATAL DIAGNOSIS 483 (1990).
80. Victoria A. Vincent et al., Pregnancy Termination Because of Chromosomal Abnormalities: A Study of 26,950 Amniocenteses in the Southeast, 84 S. MED. J. 1210 (1991); Marlon S. Verp et al., Parental Decision Following Prenatal Diagnosis of Fetal Chromosome Abnormality, 29 AM. J. MED. GENETICS 613 (1988); Arie Drugan et al., Determinants of Parental Decisions to Abort for Chromosome Abnormalities, 10 PRENATAL DIAGNOSIS 483 (1990).
81. Victoria A. Vincent et al., Pregnancy Termination Because of Chromosomal Abnormalities: A Study of 26,950 Amniocenteses in the Southeast, 84 S. MED. J. 1210 (1991); Marlon S. Verp et al., Parental Decision Following Prenatal Diagnosis of Fetal Chromosome Abnormality, 29 AM. J. MED. GENETICS 613 (1988); Arie Drugan et al., Determinants of Parental Decisions to Abort for Chromosome Abnormalities, 10 PRENATAL DIAGNOSIS 483 (1990).
82. Ecclesiastes 3:19-21; 9:2-3; see also 1 Corinthians 15:48; Romans 5:12ff.
83. See Ecclesiastes 3:1-2a ("There is a time for everything,/ and a season for every activity under heaven:/ a time to be born and a time to die").
84. Ecclesiastes 9:11-12.
85. Ecclesiastes 8:16-17. Cf. supra notes 34, 62.
86. Ecclesiastes 7:2.
87. The sense intended for "mourning" in Ecclesiastes is reviewed supra note 11, at 306-7. Furthermore, Zeanah gives a clinically useful description of the relationships among grief, mourning, and bereavement. [G]rief refers to all of the painful affects associated with loss of an infant, such as sadness, anger, guilt, shame, and anxiety. . . . [M]ourning . . . refers to a complex interplay of all the psychological processes that are triggered by the loss. This includes biological reactions, behavioral reactions, and cognitive and defensive operations related to the loss. Therefore, . . . mourning is the total psychological experience of the bereaved individual with respect to the loss. Mourning is considered to be the process by which an individual resolves a loss, that is, accepts the reality of a change in the external world and reorganizes and reorients his or her . . . world accordingly. . . . Bereavement refers to the period of time during which mourning is largely unresolved. Zeanah, A Critical Review, supra note 18, at 467-68.
88. See supra note 49 and accompanying text.
89. Ecclesiastes 9:4.
90. By going through the birth and "premature" death of a long-awaited infant, many couples have overcome their dread with faith and love to be blessed far beyond their expectations. See, e.g., James H. Pence, A Road Not Chosen, in DALLAS THEOLOGICAL SEMINARY'S KINDRED SPIRIT, Aug., 1996 at 4.
91. While supporters of the sanctity-of-life principle have historically denied any significant role for quality-of-life criteria, cases such as "Baby K" raise legitimate questions about what should be considered "futile therapy." See Reitman, Dilemma of Medical Futility, supra note 12, at 231-255). To blindly apply any and all possible life prolonging therapy when it becomes obvious that it is time to let go is also to risk presuming on divine prerogative. Cf. supra notes 35, 62 and accompanying text. See also, Jerome R. Wernow, Saying the Unsaid: Quality of Life Criteria in a Sanctity of Life Position, in BIOETHICS AND THE FUTURE OF MEDICINE: A CHRISTIAN APPRAISAL 93-111 (John F. Kilner et al., eds. 1995).
92. While supporters of the sanctity-of-life principle have historically denied any significant role for quality-of-life criteria, cases such as "Baby K" raise legitimate questions about what should be considered "futile therapy." See Reitman, Dilemma of Medical Futility, supra note 12, at 231-255). To blindly apply any and all possible life prolonging therapy when it becomes obvious that it is time to let go is also to risk presuming on divine prerogative. Cf. supra notes 35, 62 and accompanying text. See also, Jerome R. Wernow, Saying the Unsaid: Quality of Life Criteria in a Sanctity of Life Position, in BIOETHICS AND THE FUTURE OF MEDICINE: A CHRISTIAN APPRAISAL 93-111 (John F. Kilner et al., eds. 1995).
93. See supra note 68; cf. Reitman, Dilemma of Medical Futility, supra note 12, at 256-64.
94. Zeanah, A Critical Review, supra note 18; Irving G. Leon, Perinatal Loss: Choreographing Grief on the Obstetric Unit, 62 AM. J. ORTHOPSYCHIATRY 7 (1992); Irving, G. Leon, Perinatal Loss: A Critique of Current Hospital Practices, 31 CLINICAL PEDIATRICS 366 (1992).
95. Zeanah, A Critical Review, supra note 18; Irving G. Leon, Perinatal Loss: Choreographing Grief on the Obstetric Unit, 62 AM. J. ORTHOPSYCHIATRY 7 (1992); Irving, G. Leon, Perinatal Loss: A Critique of Current Hospital Practices, 31 CLINICAL PEDIATRICS 366 (1992).
96. Zeanah, A Critical Review, supra note 18; Irving G. Leon, Perinatal Loss: Choreographing Grief on the Obstetric Unit, 62 AM. J. ORTHOPSYCHIATRY 7 (1992); Irving, G. Leon, Perinatal Loss: A Critique of Current Hospital Practices, 31 CLINICAL PEDIATRICS 366 (1992).
97. The rich dynamics of perinatal hospice is described in detail in a wonderful collection of narratives from Vanderbilt University Medical Center. See Andrew Todd, 1 JOURNEY OF THE HEART: STORIES OF GRIEF AS TOLD BY NURSES IN THE NICU (2d ed. 1995). (Copies can be obtained directly from Mr. Todd at Vanderbilt University Medical Center, AAA-1200 MCN, VUMC, 1221 Second Ave. S., Nashville, TN 37232-2410.)
98. Toshihiko Terao et al., Neurologic Control of Fetal Heart Rate in 20 Cases of Anencephalic Fetuses, 149 AM. J. OBSTETRICS & GYNECOLOGY 201 (1984); Thomas J. Garite et al., Fetal Heart Rate Patterns and Fetal Distress in Fetuses with Congenital Anomalies, 53 OBSTETRICS & GYNECOLOGY 716 (1979).
99. Toshihiko Terao et al., Neurologic Control of Fetal Heart Rate in 20 Cases of Anencephalic Fetuses, 149 AM. J. OBSTETRICS & GYNECOLOGY 201 (1984); Thomas J. Garite et al., Fetal Heart Rate Patterns and Fetal Distress in Fetuses with Congenital Anomalies, 53 OBSTETRICS & GYNECOLOGY 716 (1979).
100. Todd, supra note 79, at 238.
101. Ingela Rådestad et al., Psychological Complications after Stillbirth - Influence of Memories and Immediate Management: Population Based Study, 312 BRIT. MED. J. 1505 (1996).
102. Todd, supra note 79, at Appendix B.
103. Out of 20 cases of fatal anomalies detected in our experience at Madigan Army Medical Center, only one family opted to pursue early termination.
104. See supra notes 34-37 and accompanying text.
105. Ecclesiastes 11:7-12:1. See also Reitman, Dilemma of Medial Futility, supra note 12, at 255-56, for an exposition of the implications of this passage for wise and joyful stewardship under similar circumstances of so-called medical futility.