Infanticide

Oystein Hovi Rognerud January 23, 2008 Department of Forensic Medicine Semmelweis University, Budapest

Introduction

As a part of the medical education at Semmelweis University, Budapest, the students are required to complete a two semester course in Forensic Medicine. One of the topics covered is infanticide. This paper will cover history, statistics and contemporary ethical issues surrounding infanticide.

Infanticide

Infanticide is defined as the killing of an infant, where an infant is defined as a child under the age of 1 year.1 This definition does not just cover the act of terminating the life of an infant, but also passively allowing an infant to die without intervening when this would mean saving the infants life. These two tems are defined as active and passive infanticide and in most countries they fall under the same judicial legislature and punishment. Controversial topics in public media usually involved the act of active infanticide, while in the medical community it is usually the case of passive euthanasia.

The diagnostics

In many cases the child has markings that rule out accidents and confirms that a homocide has occurred beyond a reasonable doubt. In cases where the infanticide was

witnessed, filmed or in other ways documented, or where a weapon was used ruling out any doubt of the method and who performed the act, the case is a strict legal matter and will be handled by the police and judiciary system. In most cases the evidence is not obvious and there might simply be a suspicion that an infanticide has occurred. In cases where an otherwise healthy infant is reported dead an investigation is automatically performed, including a necropsy of the infant. The doctor or police officer is often the first person to see the liveless child, other than the parents. Infanticide must be differentiated from sudden infant death syndrome (SIDS). SIDS, as defined by Beckwith is the sudden death of any infant or young child which is unexpected by history and in whom a thorough necropsy fails to demonstrate an adequate cause of death.2

History of infanticide

Infanticide has been described for hundreds of years. From the ancient Greeks and Romans to contemporary developing societies, the act of sacrificing infants in the name of religion or as cultural ceremonies has been described in numerous works of literature. The earliest evidence of infanticide consists of the remains of infants interred in building walls at the city of Jericho in 7000 B.C.; Diodorus Siculus, the Greek historian during the first century B.C., reported that the Ceylonese put to death the weak or infirm children and discarded those that had no courage or could not endure hardship.3

During the Middle Ages this culture changed and the killing of infants was seen as cruel, and those that engaged in it were punished. In modern age only specific episodes are described, such as the German infanticide incidences during the 1800s.3 In religious texts there are various accounts of infanticides, but both Jewish, Christian and Islamic scriptures condemn infanticide.

Why do parents murder?

There are several theories presented that all try to explain why a mother or father would kill their child. The main theories are based on studies done on animals in general and application to human societies and cultures4: 1. Exploitation of the infant as a resource, usually cannibalism 2. Competition for resources 3. Sexual selection 4. Parental increase of the own lifetime reproductive success by eliminating particular offspring 5. Social pathology Human infanticide includes examples of all of these functions (Daly and Wilson 1984; Dickemann 1984; Hrdy and Hausfater 1984; Scrimshaw 1984).4 Often a mental or strong physical deformity in the infant is a reason for the parent or both parents to commit infanticide.

Female infanticide

As populations grow the issue of overpopulation and lack of resources approaches. Due to social structure in some cultures and limitations to the number of children, the preferance of male children to female children has become a social and ethical problem in some countries. This has also brought about the concept of female infanticide: Female infanticide is the intentional killing of baby girls due to the preference for male babies and from the low value associated with the birth of females.5

India and the cultural structure

India has a social structure that makes it beneficial for a family to favor male offspring to that of female. As one researcher stated: in rural India, the centuries-old practice of female infanticide can still be considered a wise course of action.6

China and the one child policy

To battle overpopulation Chinese authorities have implemented a one child per couple policy. Since male children are valued higher due to their status in society and higher prospects of professional success and income, many female babies are anonymously left up for adoption or allegedly killed.

Two researchers claimed that in 2004 comprehensive new data showed that traditional family patterns in China, combined with tough population-control measures, have resulted in female infanticide on a grand scale - close to 800,000 baby girls abandoned or killed in a single region between 1971-80 alone.7

Statistics

Although infanticides are discussed in literature for centuries, the demographics of infant deaths is a modern phenomenon. Infanticide in the U.S. has drastically decreased over the last fifty years and has been fairly stabile over the last 15 years (Table 1.1)

Table 1.18

Table 1.28

60% of the children were murdered by one or both of their parents (table 1.2) 83% were murdered by parents or someone they knew well (table 1.2) Of those children killed by someone other than their parent(s), 81% was killed by a male.8

Who is murdered?

Based on studies by Daly and Wilson (1984), and Minturn and Stashak (1982), the most frequent killed infants are4: Illegitimate children (53-57%) Weak of deformed children (53-50%) Twins and triplets (40%) Due to family size or circumstances of birth spacing (23-31%)

The general conclusion of these studies and similar ones is that the motive is elimination of unwanted infants. There used to be a huge risk involved for a woman to become pregnant. Social stigma, the huge medical risk of an abortion and the posibility that the child would be taken away from her. Solely the social stigma of unwanted pregnancies in developed societies has been a topic portraied in the arts for many decades.

Due to advancements in technology, education and medical research, use of preventive measures to avoid pregnancy and abortion as a viable outcome has replaced age-old methods of complete abstinence or infanticide as ways to avoid paternal responsibility and social dogma.

In todays society a child is almost exclusively born in a hospital or in a facility where the mother is supervised by a representative from the health authorities. In modern societies the birth of a baby by a resident mother will automatically yield citizenship and a certification of birth. In developing countries where pregnant women are routinely checked during the pregnancy and the childbirth is performed in a hospital or medical facility, the insidences of unknown childbirths have become very uncommon. A phenomenon that has gotten much media publicity is the issue of mental illness in mothers.

Mental illness

Media often portraits a parent killing his or her child as insane, but in contrast to popular belief, well under 1 percent of cases involve even the consideration of insanity, and when such a plea is used, it's unsuccessful three out of four times. And the more horrific a crime, the less likely it is that it will work.9 In cases where mental illness has been concluded, postpartum psychosis of the mother has been the leading cause. Postpartum depression is an alteration in hormone levels that leads to a markedly decreased mood and is experienced as disabling to the mother. 1015% of women experience this type of diabling mood change, ranging from depression to psychosis.10

In todays society the termination of life for a healthy infant is considered murder and covered under constitutional law. However, the rise in number of abortions and the advances in biotechnology has necessitated the rise of fields such as Bioethics. Today there are two extremes, with the Vatican on one side as the abolishers of all termination of pregnancies, and on the other side the medical communities allowing euthanasia in newborns (The Groeningen Protocols).

The Lorber Criteria

John Lorber introduced the Lorber Criteria in 1980, in which he stated that a child born with one of the following problems should be excluded from medical or surgical

treatment: advanced hydrocephalus, () total paraplegia, () scoliosis or kyphosis, () or an associated anomaly.11

These criteria implied that children born with such anomalies would be given only palliative treatment until their passing, in the understanding that their defects were so severe that this was the most ethical decision for the baby and the parents. John Lorber was a professor of pediatrics at the University of Sheffield, England, from 1979 to 1980 and his views on what was essentially passive euthanasia in practice were very controversial, but often used as a guideline in British Pediatric medicine.

These views changed in the medical community when more than 2/3 of these children survived infancy and grew up with even more severe malformations and growth retardation due to the lack of proper nutrition during infancy. The children survived despite the believed passive euthanasia.

Neither the WHO nor medical textbooks today have guidelines or cut-off limits comperable to those of John Lorber. With increasing technology and the ability to sustain life of very preterm babies, bioethics has become one of the most debated issues in modern public policy. Genetic therapy and screening has also raised issues regarding what is The boundries between infanticide, termination of pregnancies without termination of life and validification of the passing of life post-natally is a matter of higher philosophy.

Religion and defining limits

According to statistics the Catholic church has 1.093 million baptized members.12 The Pope has been very clear on the issue of abortion and the Catholic church has viewed this as the termination of life murder, as defined by Stedmans Medical Dictionary. The Catholic Church condemns all forms of termination of labor, including cases where the life of the mother is at risk () and where the woman has been victim of incest or rape.13 Since the Catholic Church is such a dominant political and cultural power in the world, policies are often dictated by its members. Especially large countries with complete religious freedom have seen a rise in ethical debates surrounding issues like abortion. This is especially evident in the USA. The conservative anti-abortion ideology is balanced by the pro-choice movement.

Roe v. Wade One of the most famous U.S. Supreme Court decisions in modern time is Roe v. Wade, where the State is entitled to, in the interest of protecting the health of the mother, can allow for the termination of pregnancies until the point where the fetus becomes viable14, with viable being defined around gestational week 28.

Peter Singer and the Utilitarian approach

Peter Singer, Ira W. DeCamp Professor of Bioethics at Princeton University, and laureate professor at the Centre for Applied Philosophy and Public Ethics (CAPPE), University of Melbourne15, is one of the most important contributors to the field of contemporary Bioethics. His views are based on an atheistic and utilitarian approach, and this is in strong contrast to that of the religious anti-abortion movements.

"If we compare a severely defective human infant with a dog or a pig ... we will often find the nonhuman to have superior capacities ... Only the fact that the defective infant is a member of the species Homo sapiens leads it to be treated differently from the dog or pig. But species membership alone is not relevant ... If we can put aside the obsolete and erroneous notion of the sanctity of all human life, we may start to look at human life as it really is: At the quality of life that each human being has or can attain."15 Peter Singer

Contemporary bioethics

The medical and judicial environment is different depending on the country. Some countries have death penalties, while others do not. Some countries have legalized abortion or euthanasia or both and some countries have made it absolutely clear that this is illegal. The Netherlands is a country known for their liberal views on euthanasia. They have also issued a guideline for euthanasia in infants: The Groningen Protocol for Euthanasia in Newborns (Table 2), although this has created a bioethical debate across in several countries. The Groningen Protocol was intended to eliminate unreported cases of infant euthanasia16, since doctors are afraid they will be prosecuted for interpreting the law in a way that makes them responsible for decisions not in strict accordance with the accepted medical standard.

Conclusion

Infanticide is defined as the killing of a child under the age of 1. Although we all know that the word killing means intentionally ending someones life, the term is only applicable to a judiciary setting. With the advances in biotechnology, medical techniques and ability to perform controlled abortions, but at the same time be able to save the life of babies that would not be able to live if not born in a modern medical institution, the debate surrounding infanticide has become a question of higher philosophical ethics bioethics. If a healthy child of 6 months is killed, the law is clear in the majority of developed countries, but if a child is born with severe deformities and life is terminated by passive euthanasia, in other words removing oneself from the situation to let nature take its course, the judicial and moral implications are vast.

For todays doctors it is important that there are clear guidelines for how to behave in given situations. What is to be determined by the mother and what is the responsibility of

the clinician or surgeon. The fear of prosecution or lack of reporting lead the Dutch to construct the Groningen Protocol, which was intended to ensure accurate reporting on infant euthanasia by the medical community. Every country is entitled, through bioethical debate and judicial legislature, to mandate their own laws regarding abortion, infant euthanasia and infanticide. Although an extremely difficult task there has to be unambiguous rules for doctors to be able to refer to, since this is a very controversial subject.

Sources

Stedmans Medical Dictionary, Lippincott Williams & Wilkins; 27 edition (2000)

Bergman AB, Beckwith JB, Ray JB. Sudden infant death syndrome. Proceedings of the

2nd international conference on causes of sudden death in infants. Seattle and London: University of Washington Press; 1969.

Kempe Rugh S., Helfer Mary Edna: The Battered Child. Page 5. University of

Chicago Press; 1999.

Infanticide: http://family.jrank.org/pages/876/Infanticide-Vctims-Infanticide.html

Case Report on Infanticide: http://www.gendercide.org/case_infanticide.html

Dahlburg, "Where killing baby girls 'is no big sin'," The Los Angeles Times [in The

Toronto Star, February 28, 1994.]

The Los Angeles Times [in The Toronto Star, February 28, 1994.]

US Bureau of Justice Statistics: http://www.ojp.usdoj.gov/bjs/homicide/children.htm

When Parents Kill Their Kids: http://www.newsweek.com/id/91534

10

Postpartum Depression: http://www.emedicine.com/med/topic3408.htm

11

Walter and Shannon: Quality of Life: The New Medical Dilemma. Page 161-170.

Paulist Press. New York; 1990

12

Annuarium Statisticum Ecclesiae (2004):

http://www.ewtn.com/library/CHISTORY/annu2004.HTM. Vatican Publishing House

13

American Catholic Organization: http://www.americancatholic.org

14

Roe v. Wade, 410 U.S. 113: http://www.findlaw.com

15

Princeton Universitys faculty website: http://www.princeton.edu/~psinger/

16

Groningen Protocol: http://www.cbhd.org/resources/endoflife/beals_2005-03-24.htm