I blogged on the very sad case of Haleigh Poutre three weeks ago, but it is back in the news and I want to think through some of the issues again.

    To remind those who might be new to the case: Haleigh is an 11 year old girl (the same age as my daughter) who has been beaten (with a baseball bat; and kicked down the stairs) by her step-parents into an irreversibly grim medical condition.  She is on a respirator and a feeding tube. If she comes off both, doctors believe that she will die in a couple of weeks.  Currently, she has been taken away from her step-father (her adoptive mother killed herself when Haleigh wound up in the hospital)  and is under the legal authority of the state of Massachusetts.  The state wants to turn off the machines (they believe she will not recover), but two doctors have come up with a split decision: one says the state can ethically turn off both the respirator and the feeding tube; the other says only the respirator should be turned off, the feeding tube should remain.  Various legal moves are being made by all sides and, for the moment, the machines will remain on. 

    There are lots of hard questions here, but I would like to focus on two:

    –  should the state wait until the legal case against the stepfather on the charges of maliciously beating Haleigh is settled before taking any action on removing the respirator and/or feeding tube?

    – which of the medical prescriptions (turn off both machines, or just turn off the respirator and maintain the feeding tube) should be followed?

     In answering these, I will be guided generally by a modernized Confucian notion of Humanity.

     I think the state should wait until there is some determination in the case of the step-father’s responsibility before any medical action is taken.  My sense is that the step-father probably is guilty of participating in the near-fatal beating.  And I believe there needs to be a public airing of the horrendous crime that has been committed here, and a public recognition of just how terribly Haleigh has been treated by virtually all of the adults in her life.  We need to acknowledge, as a society, that parental failure of this sort cannot be ignored, or excused, or qualified.  We, as a society, and particularly those of us who are parents, are absolutely bound to "cherish the young," as Confucius would tell us.  When someone goes so far to the other extreme, and repeatedly and brutally beats a child into a vegetative state, we must collectively and certainly reject and condemn the crime.

     Why should this happen before medical action is taken?  Because, I believe, Haleigh should be allowed to bear witness, even if she is silent and still, to our repudiation of the crimes of the adults who were supposed to care for her.  In fact, I would even be willing to entertain the possibility that Haleigh be brought to the courtroom so that she would be a constant and immediate and uncomfortable reminder of what is at stake here.  This is not a matter of spectacle, but a matter of respect and recognition. 

    The irony here is that if Haleigh were to die, the step-father could be charged with murder, instead of whatever aggravated assault charge may now be in the works. Indeed, his professed interest in keeping her alive looks like a ploy to avoid a more serious charge at present.  But our actions should not be taken in consideration of the step-father whatsoever.  He has most likely failed, and failed in the most egregious way, to be the father he pledged to be when he entered into a family relationship with Haleigh. 

    No, we should act in a manner that invests Haleigh’s life with as much social meaning and significance as possible now.  Any life is given meaning by its social context and parents have a particular responsibility to care for children so as to allow them to grow into meaningful social lives.  Haleigh’s parents failed to do this in the worst possible way.  Allowing her life to now become a reminder to all of us of just how seriously we, as a society, take that parental responsibility would invest her short time on earth with a larger social significance.   Let her be a quiet testament to our commitment to "cherish the young," as we publicly condemn the people who destroyed her.

    Once the step-father is disposed of, then the question becomes: should she be allowed to die?  I think she should; at least that is the idea I take from my understanding of Confucian Humanity.  Given what has happened to her, there seems to be no family to come forward to care and support her.  In those circumstances, the state should not be expected to maintain extraordinary means to keep her alive. 

    But I would agree with the doctor who says that we should first turn off just the respirator, which is a fairly aggressive intervention in maintaining her life artificially.  The feeding tube is another matter, to my mind.  I have some experience with feeding tubes (my son, Aidan, uses one) and I can say confidently that they are not really a big deal.  I know a lot of people freak out about them, but, when you think about it, it is very simple and very easy – a hole cut into the belly, a tube inserted, food run through the tube.  It is not especially costly or complicated. 

   Now, this may seem odd (and I may be talked out of this position) but it seems to me that a humane way to proceed would be to first turn off the respirator and see what happens.  Doctors suggest that they expect she would probably die within a few months.  Fine.  Why not try that and make those few months as comfortable as possible?  If she were to live for a longer period of time, then the question of removing the feeding tube could be raised (say, after a year).  At that time, if family members (her birth mother is still around, though she appears to have failed Haleigh in certain ways as well), or if, in the intervening time, someone else comes forward and forges a personal relationship with Haleigh and pledges to care for her, then let that person do the care.  It could be a beautiful thing, since it is through caring for one another that we cultivate our own Humanity.

    The one caveat here is that we should make sure that Haleigh is not being used by some group to prove a political or ideological point.  Only those who directly care for her should be involved in the decision, not politicians looking to score points with their "base" or right-to-life groups defending an abstract ideal.  Haleigh is not an abstraction.  She is a person.  And her life, like all human lives, is given meaning through the direct personal relationships that surround her.  If someone can commit to her, then that person should be given the responsibility for her care (i.e. maintaining her feeding, etc.).   Again, I am not wed to this later course of action, but I offer it here as a possible way of easing the end of her life.

UPDATE: I have a new post on the most recent 1/17/06 court decision on Haleigh, here.

Another update here, responding to the report that Haleigh’s condition has improved. (1/19/06)

MOST RECENT UPDATE: responding to some critics of how Haleigh’s case has been handled (1/20/06)