Baby Doe and the treatment of disabled newborns

On 9 April 1982 an infant with Down syndrome was born in Bloomington, Indiana, with an obstruction of the esophagus that prevented feeding by mouth. The parents refused consent to surgery to correct it. The hospital went to court the next day to override them, but an Indiana trial court, after a hearing that evening, denied the request, and a local child protection committee reviewed the case and agreed with the court. The infant, who became known as Baby Doe, died six days after birth.

On 18 May 1982, acting on a directive from the President, the Office for Civil Rights of the Department of Health and Human Services reminded hospitals receiving federal funds that section 504 of the Rehabilitation Act of 1973, which bars discrimination on the basis of handicap, protected newborns with conditions such as Down syndrome. An interim rule of 7 March 1983 required notices in delivery wards, maternity and pediatric wards and nurseries giving a federal hotline number for reporting suspected violations. On 14 April 1983 a federal district court in Washington, ruling in a suit brought by the American Academy of Pediatrics, struck the rule down for violating the Administrative Procedure Act. The department issued final rules on 12 January 1984.

Congress then passed the Child Abuse Amendments of 1984, enacted on 9 October. They defined withholding of medically indicated treatment as failing to give a disabled infant with life-threatening conditions the treatment most likely to correct them, including nutrition, fluids and medication. Treatment other than nutrition, fluids and medication could be withheld if the infant was chronically and irreversibly comatose, if it would merely prolong dying or be futile, or if it would be virtually futile and inhumane. States receiving child abuse grants had to set up procedures through their child protective services to respond to such cases.

The American Hospital Association and the American Medical Association challenged the 1984 hospital rules. On 9 June 1986, in Bowen v. American Hospital Association, the Supreme Court upheld the lower-court ruling that invalidated them. No opinion won a majority: Justice John Paul Stevens, writing for himself and three other justices, concluded that section 504 did not authorize the rules and that a hospital could not violate the law by withholding treatment when the parents had refused consent. Chief Justice Burger concurred only in the judgment.