Court Bars U.S. Rights Role in Baby Doe Cases

The Supreme Court, ruling in the Baby Doe case, said Monday that federal officials have no right to overrule the wishes of parents and require medical treatment for babies born with severe defects.

In a narrow but sharply worded decision, the justices criticized the Reagan Administration’s attempt to use a 1973 anti-discrimination law to justify a “vigorous federal role” on behalf of severely ill infants.

The law in question applies to recipients of federal funds such as hospitals but not to parents, the high court said in a 5-3 decision.

Burger Joins Decision

“Nothing in this statute authorizes the secretary (of health and human services) to dispense with the law’s focus on discrimination and instead to employ federal resources to save the lives of handicapped newborns,” Justice John Paul Stevens wrote for three other justices. Chief Justice Warren E. Burger joined in the judgment.

The Baby Doe ruling grew out of the highly publicized case of an infant born in Bloomington, Ind., in April, 1982, suffering from Down’s syndrome and a blocked esophagus. The baby was allowed to die after the parents refused to permit surgery to remove the blockage.

In response, President Reagan urged federal health officials to treat this as a violation of the child’s civil rights. The next year, federal officials informed hospitals that such babies were protected under federal law, and new regulations created such enforcement mechanisms as a 24-hour hot line to report abuses. State officials were required to begin “immediate . . . on-site investigations” when they received reports of “suspected unlawful medical neglect.”

Justice Stevens said those rules went far beyond the language or intent of the law. Federal officials are not authorized “to give unsolicited advice either to parents, to hospitals or to state officials who are faced with difficult treatment decisions concerning handicapped children,” he wrote.

Moreover, Stevens said, the Administration had no authority to try “to commandeer state agencies to enforce compliance” with federal directives. Stevens’ opinion upheld a ruling by a federal appeals court in New York striking down the regulations.

Medical and hospital industry spokesmen applauded the ruling (Bowen vs. American Hospital Assn., 84-1529). The decision was a strike against “government intrusion in the hospital nursery,” said Richard Epstein, an attorney for the American Hospital Assn. in Chicago.

Justice Department spokesman Terry Eastland, although expressing disappointment with the outcome, saw a “ray of hope” in the opinion because it suggested that “regulations can be upheld if the government provides specific instances where hospitals discriminated against handicapped infants.”

Lawyers for disabled people said that the court ruling gives too much weight to the views of the medical community.

“There is a medical bias that sees disabled people as having bleak and tragic lives,” said Deborah Kaplan, a San Francisco attorney who has worked for the Disability Rights and Education Fund in Berkeley. “I’ve seen too many cases where parents had to fight like hell or move to another hospital to get treatment for their babies.”

Thomas Gilhool, a lawyer who represented the American Coalition for Citizens with Disabilities, called the court’s opinion “extraordinarily simple-minded” and said it absolves hospitals of responsibility because the parents did not consent to treatment for their baby. In many, if not most, such cases, Gilhool said, it is doctors and hospital officials who counsel parents to stop further treatment.

The impact of Monday’s decision may be blunted, however, because Congress in 1984 said that “the withholding of medically indicated treatment” from handicapped infants could be considered an example of child abuse. Although this strengthened federal law does not apply directly to hospitals, as the Administration had wished, it does give state officials more authority to intervene in some Baby Doe cases.

Since the Baby Doe controversy arose, medical authorities say, physicians have become more aggressive in treating babies with defects such as Down’s syndrome, a chromosomal abnormality that causes mental retardation.

Stevens was joined in the decision by Justices Thurgood Marshall, Harry A. Blackmun and Lewis F. Powell Jr. Burger voted to strike down the “Baby Doe” regulations but did not sign Stevens’ opinion.

Rehnquist Not Involved

Justices Byron R. White, William J. Brennan Jr. and Sandra Day O’Connor dissented. Justice William H. Rehnquist did not participate in the case for unstated reasons.

In another case--one that could lead to widespread constitutional challenges to capital punishment--the justices agreed to decide whether a convicted murderer in Florida must be allowed a hearing on his contention that the death penalty is being applied arbitrarily on the basis of race.

The justices will review next term a petition by James Ernest Hitchcock seeking a hearing to present statistical evidence showing that killers of whites are sentenced to death more often than are killers of blacks.

A ruling by the justices allowing unconstitutional discrimination to be proved by data showing racial disparities in capital punishment could lead to countless similar challenges among the more than 1,700 inmates now on Death Row nationwide.

Death penalty foes see such challenges as perhaps the last remaining broad-based attack that can be made on capital punishment. Hitchcock, who is white, was convicted and sentenced to die for the 1976 strangulation murder of Cynthia Driggers, his brother’s 13-year-old stepdaughter (Hitchcock vs. Wainwright, 85-6756).

Times Medical Writer Robert Steinbrook contributed to this story.