The headline in the June 14 Oregonian reads: "Prenatal testing goes to court."  The accompanying article describes a Portland couple suing a doctor for $14 million to cover the costs of raising their daughter, who was born in 2007 with Down syndrome.  The suit alleges that the doctor assured the couple their child would not have the disability. The couple says that had they known of the condition, they would have chosen abortion. Read more about the suit on OregonLive. 

Similar lawsuits -- called “wrongful birth” and “wrongful life” cases -- have raised complex legal, ethical and moral issues across the country.  Some would say that a botched prenatal test is like any other mishandled medical procedure and should be treated as medical malpractice.  Others would ask if a person can truly be damaged because she is alive.

One sentence in the article particularly grabbed my attention:  “Several studies show 90% or more of women who discover they’ll give birth to a baby with Down syndrome choose to have an abortion.”  Angela Jarvis-Holland of the Northwest Down Syndrome Association comments that this seems to reflect a “tyranny of perfection.”  As medical science advances, parents will be able to test for “virtually every conceivable disadvantage facing their fetus.”   Will parents of the future sue their doctors if their child does not have the desired height, athletic ability or IQ? 

 An approach to addressing these issues is contained in a section of the Pregnant Women Support Act (S.270), now pending in the U.S. Senate.   It would require health care providers to provide information to parents who receive a positive test result from a prenatal test for Down syndrome.  That information is to include written, up-to-date, scientific information about the syndrome and referral to support services including a hot-line, website, peer-supports and national registry of adoption options.

One’s view of this proposal is bound to be highly affected by one’s position in the larger abortion debate.  But if I can gingerly sidestep that issue, I would like to raise the relationship of  “wrongful life” cases to health care reform.

 I wonder: What if everyone had insurance that covered the additional costs of raising a child with disabilities?  What if there were no fiscal incentives to abort a child with Down syndrome? It would not affect the choice of a person who only wants to carry a child that has a good shot at Harvard or the Trail Blazers' roster; but it could save us from putting a negative price on life.

Recent news reports about the official sanction of, and guidelines for, torture (or, if you prefer, "enhanced interrogation techniques"), brought me back a couple of years to some work I did for the government.  I was on a monitoring team, checking out a Protection and Advocacy organization in the Midwest.  A member of the team had recently returned from Guantanamo where he had worked as a mental health therapist for prisoners.

Unable to resist, I asked him what it was like.  I had heard that many prisoners were attempting suicide or other self-harm.  He told me that all the prisoners received excellent care and that their psychiatric records were sent to Washington every day for review at the Pentagon.  He said that the prisoners were very scary, noting that having someone stare at you who you know would like to kill you was a chilling experience.

Recent documents that the government has released show that medical personnel were always present at water-boarding sessions in order to assure that the prisoner did not die in the process.  All treatment of the prisoners was under medical supervision.  This, according to defenders of the interrogation techniques, demonstrates that the interrogators were not truly engaged in "torture."

When I recently read that one of the prisoners who received a lot of "enhanced techniques" probably had a psychotic disorder, a number of thoughts came to mind.  These prisoners had been sent to a place that was out of the way where nobody could see what was happening.  They were often held in segregation even when known to be mentally ill.  While it is generally understood that segregation exacerbates mental illness, exacerbation seems to have been the purpose for all prisoners, not just those with mental illnesses.  The medical staff who were there to care for them were, at least in the case of the fellow I met, deathly afraid of them.  Those same medical personnel monitored enhanced techniques that were performed in order to protect society from harm. 

Defenders of the program seem to assume that inflicting mental and emotional pain cannot be categorized as torture.  Driving a person into psychosis and suicidal action is one of those items that does not seem to be considered as severe as causing organ failure.

Back here in Oregon, we put many hundreds of mentally ill people into jails, prisons and the state forensic hospital each year.  Many end up in segregation for behaviors associated with their mental illness.  The staff who oversee them are often scared of them.  Officials who are responsible for putting them in custody, often want them to stay behind high walls regardless of their mental condition or their risk of harm because the public is afraid of them.  All of these inmates and patients are under some form of medical care and supervision that is provided with the resources and in the environment at hand.

I am not suggesting that Oregon officials are engaging in torture.  But are we causing some of our fellow citizens unnecessary mental anguish in order to feel more secure?

The public is now turning to a debate of whether torture is justified if it can yield life-saving information.  How do we justify our treatment of Oregonians with mental illness?