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The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey findings, both because of the acknowledged limitations of survey methodology, and because survey conclusions cannot, in themselves, yield answers about what the right threshold should be for providing or withholding treatment.2
In this brief response, we are going to address head-on the important ethical question raised within our survey – when life is worth living for an infant. We follow-up on the suggestion of two commentators that the presence or absence of “relational potential” might be ethically important to report in studies of the outcome of severely impaired infants,3 and to whether parental requests for treatment should be supported.4
The notion of “relational potential” was introduced by John Arras in a 1984 commentary.5 Arras was responding to the Baby Doe Regulations and a …
Funding JS was supported for this work by grants from the Wellcome trust WT106587/Z/14/Z, WT203132/Z/16/Z.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
↵We do not want to claim that biological life below the relational threshold has zero value. Such individuals might have some positive wellbeing. Rather, the idea is that this is a threshold for a particular (and important) kind of value to be realised.
↵In some philosophical contexts, ’self-consciousness’ is taken to refer to a fairly high-level capacity — such as having a concept of self. It’s something that no infant has, even if perfectly normal. But we take it that that high-level capacity is not really necessary for a minimal two-way relationship (and suggest that normal newborn infants do have relational capacity).