アメリカにおける重症新生児の治療中止 : 連邦規則の批判的考察とわが国に対する示唆  [in Japanese] Medical Decision-making for Severely Ill Newborns : What We Can Lesrn from the Critical Analysis of the Child Abuse Amendments of 1984 and its Regulations  [in Japanese]

Child Abuse Amendments of 1984 and its Regulations areenacted after the so-called Baby Doe Cases, where parents refused treatment of their seriously ill newborns. Even though the Act and its Regulations have a noble ideal not to letthe newborns' parents refuse treatment based on their children's handicap, they are criticized as follows: they concentrate too much on the refusal of treatment cases and make light of the parental rightto decide for the child. Also, they are criticized as disregarding the newborns' pain and suffering from continuing the treatment, which should be a factor to determine "the best interests of the child". As to the latter criticism, the Act and its Regulations don't assume cases of medical abuse where parents insist on providing futile treatment. However, since providing futile treatment can be againstthe "best interests of the child", it is asserted thattreatment decisions have to be made depending on the particular facts of the cases, and not on the comprehensive ban of refusal of treatment like the current regulations. When we look to the situation in Japan, there are guidelines called "Guidelines for Healthcare Providers and Parents to Follow in Determining the Medical Care of Newborns with Severe Disease" published by a research group subsidized by the Ministry of Health, Labour and Welfare. The Guidelines aim to pursue the best interests of the particular child in question in determining the medical treatment of that child and in that sense, the ideal they have is commendable. As this article suggests, medical decisions for the newborns should be made based on the best interests of the child considering the particular facts of the cases as the Guidelines try to achieve, and not based on the regulatory scheme to ban the refusal of treatment except for narrow and vaguely-defined circumstances.