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Ronald Reagan Presidential Library
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This is a PDF of a folder from our textual collections.
Collection: Blackwell, Morton C.: Files
Folder Title: Staffing Memoranda 1983
(5 of 6)
Box: 65
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THE WHITE HOUSE
WASHINGTON
May 31, 1983
MEMORANDUM TO: Faith Ryan Whittlesey
FROM:
Morton C. Blackwell ALB
SUBJECT:
Draft Presidential Remarks:
Reception for Council of the Americas
In the 3rd paragraph, 3rd sentence, the words, "Marxist
socialism" should be replaced with "Marxism."
There is no need for the President to distinguish between
"Marxist socialism" and any other kind of socialism. The
word "Marxism" suffices. The President is not advocating
any non-Marxist socialism and therefore the term "Marxism"
could stand rhetorically by itself and be parallel with
the word "socialism" which is found in the next paragraph.
MCB:jet
JV, MB COMMENTS TO MARYBETH BY 11:30 am TODAY 5/31/83
Document No.
WHITE HOUSE STAFFING MEMORANDUM
NOON TUESDAY
DATE: May 27, 1983
ACTION/CONCURRENCE/COMMENT DUE BY: May 31, 1983
SUBJECT: Draft Presidential Remarks: Reception for Council of the Ameri
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
P
HARPER
BAKER
HERRINGTON
DEAVER
JENKINS
STOCKMAN
MURPHY
CLARK
R
ROLLINS
DARMAN
P
55
WHITTLESEY
DUBERSTEIN
WILLIAMSON
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
Bakshian
Fischer
REMARKS:
Please forward comments/edits directly to Aram Bakshian, with a
copy to my office, by Noon Tuesday, May 31.
Thank you.
RESPONSE:
She mesno attached
Richard G. Darman
Assistant to the President
(Rohrabacher/AB)
May 27, 1983
6:30 p.m.
PRESIDENTIAL REMARKS: RECEPTION FOR COUNCIL OF THE AMERICAS
WEDNESDAY, JUNE 1, 1983
Welcome to the White House. Since getting to Washington
I've been stressing that there is an important role those of you
in business have to play in solving the vexing problems that
confront us. Well, perhaps the most vexing of all is coming to
grips with the challenges we face in Latin America, especially in
nearby Central American and Caribbean countries.
I'd like to take this opportunity to thank each of you, and
the business enterprises you represent, for what you're doing to
bolster the economic progress of the hemisphere. Freedom and the
profit motive are still two of the most powerful forces known to
man. Together we've got to make sure that they are put to work
throughout the hemisphere.
It is almost a cliche to say that every problem is a
potential opportunity, but that doesn't make it any less true.
Today, people are looking for new alternatives. MarxistM
socialism has totally failed to meet the needs of third world
countries. Those sincerely searching for solutions are now
looking to the business community, especially American business,
to show them how to get their jobs done.
They've found that socialism can provide rhetoric, but it
doesn't put food on the table.
I'll be meeting with the President of the Ivory Coast next
week. And although there have been problems the Ivory Coast has
suffered as a result of the world recession, that country, with
Page 2
an emphasis on free enterprise, has accomplished so much in
comparison to African countries that took a different route. And
the same is true in this hemisphere.
Recently, when I was visiting Miami, I was struck by the
vitality of the Cuban community there. Only 90 miles away in
Cuba the basic necessities of life are still being rationed.
There is one figure that tells it all. The 1 million Cubans in
the United States produce almost twice as much wealth as the
10 million they left behind. We've got something and it works.
And just as important, we're willing to share it. We want
nothing less than the blessings of plenty for every nation of the
New World.
I can think of nothing more important to the security of our
country than building strong and healthy economies throughout the
Western Hemisphere. One of the goals I've set is a new
solidarity in the hemisphere. The people here have so many
fundamental values that tie us together. Most of us are
descended from pioneers who gave up everything to come to the New
World in order to better themselves and their families.
Today, the efficiency, resources, and know-how of American
business are as legendary as the spirit of those pioneers. Your
role is no less historic. In Central America, in the Caribbean,
and throughout Latin America, your enterprise will have
tremendous impact on the political and economic future of the
hemisphere. so, we are grateful to you for your resourcefulness
and want to encourage you to be bold and to spread American
Page 3
enterprise throughout the hemisphere. That is a job you can do
better than anyone else.
Thank you for being here today, and God bless you.
Document No.
PL
WHITE HOUSE STAFFING MEMORANDUM
OFFICE OF PUBLIC LIAISON
DATE: 5/25/83 ACTION/CONCURRENCE/COMMENT DUE BY:
SUBJECT: assor. of Clander y Commerse in
Letin america
ACTION
FYI
ACTION
FYI
WHITTLESEY
TILLER
VIPOND
VILA
ROUSSELOT
GRAF
BLACKWELL
SUNDSETH
BUCKALEW
MORECI
GALE
JACOBI
JEPSEN
REMARKS:
for fillow then
RESPONSE: to BLACKWEUT
Mont WOULD you PLEASE Look AT
THIS $ RETURN IR I New TOBE INVOLVED
Handled. they are 113 now swoked.
Faith Ryan Whittlesey
Assistant to the President
Ext. 2270
OF STATE
staff
Washington, D.C. 20520
to file
JHR
May 25, 1983
Note to Amb. Whittlesey and Mr. Blackwell
Subject: Involving Association of American Chambers of
Commerce in Latin America in Central American Outreach
gar
Effort
TO Mont B.
I recommend that you involve the AACCLA in your Central
American outreach effort. The Association has about 18,000
corporate members throughout Latin America, about 50%
representing U.S. companies.
Alexander Perry, Jr., the First Vice President and former
President of the organization (an old friend from my St. Joe
Minerals days) and Keith Miceli (the AACCLA's paid permanent
Washington representative) both tell me that the Association
is fully supportive of the President's Central American
policies and would welcome more information.
I suggest two things:
1. That Miceli be included in meetings or briefings
of Washington business representatives on this issue.
2. That a briefing of the AACCLA's President (stationed
in Mexico) and regional vice presidents from Central America
and the Caribbean be arranged. Miceli tells me that this
could be done with a few days' advance notice.
Miceli's telephone number is (202) 463-5485.
This
Charles Carlisle
Document No.
PL
WHITE HOUSE STAFFING MEMORANDUM
OFFICE OF PUBLIC LIAISON
DATE: 5/25/83 ACTION/CONCURRENCE/COMMENT DUE BY:
SUBJECT: assor of Clander y Commerse in
Letin amain
ACTION
FYI
ACTION
FYI
WHITTLESEY
TILLER
4
VIPOND
VILA
ROUSSELOT
GRAF
BLACKWELL
SUNDSETH
BUCKALEW
MORECI
GALE
JACOBI
JEPSEN
REMARKS:
for follow then
RESPONSE: gift to BLACKWEUT
MORT WOULD You PLEASE Look AT
THIS $ RETURN IR It New to BE IMOLIAD
Handled. they are 113 now smoked
Faith Ryan Whittlesey
Assistant to the President
Ext. 2270
Department OF STATE
staff
Washington, D.C. 20520
to file
JH12
May 25, 1983
Note to Amb. Whittlesey and Mr. Blackwell
Subject: Involving Association of American Chambers of
Commerce in Latin America in Central American Outreach
gar
Effort
TO Mont B.
I recommend that you involve the AACCLA in your Central
American outreach effort. The Association has about 18,000
corporate members throughout Latin America, about 50%
representing U.S. companies.
Alexander Perry, Jr., the First Vice President and former
President of the organization (an old friend from my St. Joe
Minerals days) and Keith Miceli (the AACCLA's paid permanent
Washington representative) both tell me that the Association
is fully supportive of the President's Central American
policies and would welcome more information.
I suggest two things:
1. That Miceli be included in meetings or briefings
of Washington business representatives on this issue.
2. That a briefing of the AACCLA's President (stationed
in Mexico) and regional vice presidents from Central America
and the Caribbean be arranged. Miceli tells me that this
could be done with a few days' advance notice.
Miceli's telephone number is (202) 463-5485.
This
Charles Carlisle
LV, MB Comments to Marybeth by
3:00 FRIDAY 5/27
Document No.
WHITE HOUSE STAFFING MEMORANDUM
DATE:
May 26
ACTION/CONCURRENCE/COMMENT DUE BY: c.o.b. TOMORROW
RESPONSES TO QUESTIONS SUBMITTED BY GUNOWNER MAGAZINE
SUBJECT:
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
HARPER
BAKER
JENKINS
DEAVER
MURPHY
STOCKMAN
ROLLINS
CLARK
WHITTLESEY
DARMAN
P
SS
WILLIAMSON
DUBERSTEIN
VON DAMM
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
Remarks:
Please provide any edits directly to Mike Baroody, Ext. 7170, Room 160,
by c.o.b. tomorrow, Friday, May 27th, with an information copy to
my office.
Thank you.
Richard G. Darman
Assistant to the President
(x2702)
Response:
This s OK.
May 1983
GUN OWNER MAGAZINE
1. Mr. President, during your acting career, you played many roles
using a firearm. Are you also a shooter in private life? And,
if so, what are your favorite guns?
I do a little target shooting at the ranch with hand guns -- but
I really can't say that I have a particular favorite.
2. I understand that you have a collection of Old West firearms.
What got you started collecting them and which are your
favorites?
I made several Western films during my time in Hollywood and when
I was associated with "Death Valley Days." Along the way, my
interest in things associated with the Old West grew and, on one
occasion, a fan sent me an old gun. Frankly, I would not call my
collection strictly a "gun" collection as it includes many other
things associated with the West -- saddles, other items of tack,
and artworks. The six-gun was an invaluable part of the opening
up of-the West and it played a vital role in our nation's
history. My collection of Americana has special meaning in that
it is an expression of my feelings about our country.
3. We all know of your love of the outdoors and particularly horse-
back riding. Do you hunt and, if so, what are your favorite
types of hunting?
Actually, I'm not a hunter at all. Never have been.
4. Gun owners throughout the country took an active role in your
campaign in 1980. Many are now anxious to know whether you will
seek a second term in the White House. Are you close to making a
decision about re-election in 1984?
Well, we only have to look at our friends over in the Democratic
party to realize that campaign fever is starting up again. Now
as to my own intentions, all I can say right now is what I've
said many times before -- no decision -- one way or the other --
has been made. When it has been, I'll waste no time in letting
everyone know.
5.. What would motivate you to seek reelection?
I've said I don't like to walk away from an unfinished job. It's.
just not my style.
6. Mr. President, the Bureau of Alcohol, Tobacco and Firearms (BATF)
continues to harass individual gun owners, and seems to spend
more time on "Mom and Pop" gun stores with minor infractions than
on organized crime and major felony violations of our gun laws.
Do you favor putting the regulating division of the BATF back
into the Treasury where it was 10 years ago and place the
functions of firearm enforcement in a smaller agency?
I am pleased to report that there has been great improvement in
relations between the firearm enforcement component of BATF and
gun owners and licencees since I took office more than two years
ago. I intend to see it remain that way. That is why, among
other technical, administrative, and policy reasons, my Admin-
istration last year proposed the transfer of the BATF Firearms
enforcement functions and related personnel to the U.S. Secret
Service. The firearms component of BATF is now doing a fine job
concentrating on organized crime and drug-related major felony
violations of gun laws.
7. Do you support changes and modifications of the 1968 Gun Control
Act as proposed in legislation authored by Senator James McClure
and Representative Harold Volkmer?
I support changes and modifications of the 1968 Gun Control Act,
a number of which are already embodied in the legislation
sponsored by Senators James McClure and Orin Hatch and Repre-
sentative Harold Volkmer. My Administration is working closely
with sponsors of firearms reform legislation to produce a bill
that truly protects the rights of law-abiding citizens without
diminishing the effectiveness of criminal law enforcement against
the misuse of firearms. I look forward to signing such a bill.
8. We all greatly admired your courage in dealing with the assassi-
nation attempt in 1981. We especially admired the fact that this
incident did not weaken your long standing opposition to more
stringent gun control laws. Would you explain why?
The attempt was made in Washington, D.C. -- which has some of the
strictest gun control laws in the country, they didn't prevent my
assailant from getting a gun.
9. As you know, Gun Owners has grown in the last 6 years to become
one of the country's largest political action committees (PACs).
Now, the ultra-liberals in Congress are trying to outlaw PACs or
drastically restrict our ability to participate politically.
Would you veto any legislation which would restrict Gun Owners'
ability to participate through their collective efforts?
Some people think PACs should be limited. I don't favor passing
laws to restrict free speech and active participation in politics
by any individuals or groups. Instead of limiting what PACs can
do, I'd rather ease the limits on what political parties can do.
That's why I'm supporting legislation currently introduced by my
friend Paul Laxalt in the Senate and my friend Bill Frenzel in
the House. Both bills will go a long way in restoring our
political parties to their rightful place in the American
political process.
10. Justice Sandra Day Connor, your first appointment to the
Supreme Court had a very strong pro-gun record in Arizona. Can
we look forward to future judicial appointees sharing that
philosophy?
My appointment of Justice σ' Connor to the Supreme Court was based
on a wide variety of factors. To limit the deciding factor to
her position on gun control would be misleading and unfair to
her. My feelings on the role of the Court within the framework
of American life are well-known and a matter of public record.
Justice Connor, in my opinion, shares those views. It is this
type of compatibility that a President is looking for in making
such an appointment. If in the future, I have the opportunity to
appoint another member to the Court, the same factors that
entered into the 0' Connor appointment, will come into play.
11. There is a lot of confusion in the minds of many people about the
meaning of the Second Amendment. What does it mean to you?
As I recently stated at the NRA convention on May 6, 1983, the
Constitution does not say that Government shall decree the right
to keep and bear arms. The Second Amendment of the Constitution
does say
"
the right of the people to keep and bear arms shall
not be infringed." That seems pretty clear to me.
12. Finally, Mr. President, I'm interested in knowing what is your
most memorable moment so far of your Presidency?
It would be impossible to pin down one moment because there have
been so many. I am sure that every President remembers his
Inauguration and, with the release of the American hostages, mine
was especially memorable. Then, of course, there was the day of
the attempt on my life when three other fine men were also
seriously wounded. It is a very negative memory, but one which
will always stand out. Another sad occasion, which was also an
historical one, was the night three former Presidents landed on
the South Lawn of the White House on their way to the funeral of
Anwar Sadat. It was a very dramatic moment and the terrible
event which had initiated it had shook the whole world. On the
positive side I cannot leave out my meeting with Mother Teresa of
India. Although she is a very diminutive woman with a quiet
demeanor, she possesses an awesome power to make God's love a
living reality. Lastly, I must mention the many handicapped and
seriously ill children who have visited me in the White House.
When I look in their eyes, somętimes I see their pain, but most
often I see their bravery, their determination, their joy and I
know that I have seen the hope of our future.
Questions Omitted
*
The leading Democratic contenders for president, Walter Mondale,
Alan Cranston and Gary Hart are all strongly anti-gun. Yet,
initiatives to enforce gun control in Massachusetts and
California have recently been defeated. How do you explain this
contradiction? What does this ported for the 1984 election?
Morton Grove, Illinois, has a law outlawing handgugns while
Kennesaw, Georgia requires every resident to own a firearm unless
there is a conscientious objection. The rate of violence in
Morton Grove has remained virtually the same while it has gone
way down in Kennesaw after the enactment of each ordinance. How
do you explain the difference?
*
There seems to be an international movement for disarmament. Do
you feel that Americans will be more vulnerable if they are
personally disarmed?
A number of people appreciated Nancy's comment about keeping a
small gun by her nightstand for protection. What kind of public
reaction did you receive on her statement?
JV, MJJ, JHR, DJ, MG, JB, LK, JT
Document No.
PLEASE
TVIPOND
JV -- RESPOND DIRECTLY TO ABAKSHIAN WITH EDITS BY NOON
WHITE HOUSE STAFFING MEMORANDUM
DATE:
May 25
ACTION/CONCURRENCE/COMMENT DUE BY: NOON TOMORROW
RADIO ADDRESS: RE WILLIAMSBURG SUMMIT
SUBJECT:
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
HARPER
BAKER
JENKINS
DEAVER
MURPHY
STOCKMAN
ROLLINS
CLARK
WHITTLESEY
DARMAN
OP
WILLIAMSON
DUBERSTEIN
VON DAMM
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
BAKSHIAN
FISCHER
Remarks:
Please provide any edits directly to Aram Bakshian by noon tomorrow,
Thursday, May 26th.
Note: This has been forwarded to the President.
Richard G. Darman
Assistant to the President
(x2702)
Response:
This in O.K.
M. Bloohwell 5/26/83
JV, JHR, MJJ, MB DJ, MG, JB COMMENTS BY 9:30 5/23 TODAY
Document No.
WHITE HOUSE STAFFING MEMORANDUM
10:00 A.M. MONDAY
DATE: May 21, 1983
ACTION/CONCURRENCE/COMMENT DUE BY: May 23, 1983
SUBJECT: DRAFT PRESIDENTIAL REMARKS RE MX FOR THE CONGRESSIONAL DINNER
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
HARPER
BAKER
JENKINS
DEAVER
MURPHY
STOCKMAN
ROLLINS
CLARK
WHITTLESEY
DARMAN
P
ISS
WILLIAMSON
DUBERSTEIN
VON DAMM
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
Bakshian
Fischer
Remarks:
These draft remarks have gone forward to the President. Please
provide minor edits directly to Aram Bakshian, with a copy to my
office, by 10:00 a.m. Monday, May 23.
Thank you.
Richard G. Darman
Assistant to the President
(x2702)
Response:
This is too weak a statement.
Building MX as a means to reduction is
Allowing the Soviets to enjoy superiority is not
not the only argument.
acceptable to the public. that too should be stressed
(Bakshian)
May 21, 1983
Noon
PRESIDENTIAL MX REMARKS: CONGRESSIONAL DINNER
MONDAY, MAY 23, 1983
Thank you all for being here. I know the heavy legislative
workload each of you has to deal with and the many other demands
on your time. I wouldn't have asked you here tonight if I
weren't convinced that the subject of this gathering is one of
overriding importance.
Now I know that the debate on the MX Peacekeeper missile,
and the whole issue of strategic modernization, has been going on
for a long, long time. And when a debate runs on and on as this
one has, the tendency is to think that we've. already heard
everything on the subject that's worth hearing. Certainly, we've
all been subjected to the paper equivalent of saturation bombing
on this issue. The long-winded arguments have been thrown at us
from every side. But I can't help wondering if the very
intensity and length of the debate may have made it harder to see
the forest for the trees.
Here we are tonight, just hours away from the House and
Senate votes -- votes which I deeply believe may be among the
most important that the Members of both chambers will be called
upon to make in their entire careers. So, in these final hours
before the decision is made, I very much wanted a chance to meet
with those of you, of both parties, who still have an open mind
on the question -- who are still struggling to reach the right
decision, the decision that will be best for the people you
represent, and for our country, now and tomorrow.
Page 2
We all know what the vote will be about. The specific
legislative proposal is to approve flight testing of the
MX Peacekeeper missile and the work necessary for basing it in
existing Minuteman silos. Implicit in this vote is approval of
the production of the missiles. And this is the first essential
step toward deployment of 100 Peacekeeper missiles beginning in
1986, and for the development of a new, small, single-warhead
ICBM which would be mobile.
The terms of the question are clear enough. What is perhaps
less understood is why it is such an important question. My
answer to that is two, simple words: arms reductions --
balanced, verifiable arms reductions that can make the world of
tomorrow a safer place for all the Earth's people. And that, I
am convinced, is a goal we all share -- an issue that cuts across
liberal-conservative and Democratic-Republican lines and should
unite us as Americans and as members of the human family.
When I endorsed the Scowcroft Commission's recommendations,
I did so because I felt they balanced three elements
indispensable to our country's present and future well-being:
modernization, deterrence, and arms control. All are important,
but the key is that they are also interdependent. Modernization
programs -- like the MX Peacekeeper -- go hand-in-hand with
deterring nuclear war and achieving arms control.
Make no mistake. The MX and other modernization measures
will be invaluable in helping us to strengthen the peace by
seeking arms reduction agreements -- agreements that make for
more security and stability by reducing overall force levels
Page 3
while permitting the modernization of our forces needed to
maintain a credible deterrent.
The Scowcroft Commission proved that this is not a partisan
issue. Its members, drawn from both parties, several previous
administrations, and a wide range of technical experts, showed
that it's possible to grasp a complex, emotional issue of immense
importance, to rise above politics, and to achieve a bipartisan
consensus.
The members of the Commission agreed on the need to build
and deploy the MX, and to build the smaller, single-warhead
missile, not so we can fight a war or add more useless tonnage to
the nuclear arsenal. They agreed because they are convinced, as
I am, that their recommendations, if followed, will persuade the
Soviets that it is in their interests, too, to agree to deep arms
reductions. And that's something we all want.
The question now before us is whether the Congress can also
reach a consensus, a consensus that will unite us in our common
search for ways to strengthen our national security, reduce the
risk of war and, ultimately, reduce the level of nuclear weapons.
Such a consensus is not just desirable. It is crucial to
America's future -- indeed, to the future of all the civilized
values we hold dear and seek to protect from mass destruction.
If we can build that legislative consensus now, it can be
sustained from one administration to the next, from one party to
another, and lay the groundwork for steady progress toward arms
reduction and a more peaceful and secure world.
When I say this is a bipartisan issue, I mean it. In fact,
I want to close by quoting a liberal Democratic Member of the
Page 4
House, Dan Glickman of Kansas, who explained why he had changed
his mind and decided to back the MX a few days ago in the pages
of the Washington Post. Here is what he said:
"To kill the MX now, I have come to believe, may indeed
reduce the Soviets' inclination to 'give' on their giant
land-based missiles, which is the heart of what we want in an
arms control agreement. I have come to the conclusion that the
basic question is this: Will the funding for MX help or hurt our
ability to reach an ultimate reduction in nuclear weapons
arsenals? It is a very close question but, on balance, I believe
that we are closer to an agreement and to a reduction
if we
proceed -- at least initially -- on funding for the missile." "
Thank you, Dan Glickman.
I was not being over-dramatic when I said that this may be
one of the most important votes any of you will ever be called on
to cast. For that very reason, I respect you for taking a long,
hard look at the issue before making up your minds. But I'm
convinced that, as we reach the eleventh hour, the choice is
clear: A vote for the MX is a vote for what all of us want for
our country and for posterity -- a better chance for peace, for
security, and for a real beginning toward arms reductions.
I can't think of any higher goal for us to work for together
and I urge you think hard on this one from the perspective of our
Nation's future and the kind of world our children will inherit.
Thank you all for coming this evening, and God bless you.
AT OPL STAFF COMMENTS TO MARYBETH BY 10:30 a.m. 5/23 TODAY
Blactwell
Document No.
WHITE HOUSE STAFFING MEMORANDUM
11:00 A.M. MONDAY
DATE: May 21, 1983
ACTION/CONCURRENCE/COMMENT DUE BY:
MAY 23, 1983
SUBJECT: DRAFT PRESIDENTIAL OP-ED PIECE FOR WASHINGTON POST
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
HARPER
BAKER
JENKINS
DEAVER
MURPHY
STOCKMAN
ROLLINS
CLARK
WHITTLESEY
DARMAN
P
uss
WILLIAMSON
DUBERSTEIN
VON DAMM
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
BAKSHIAN
Remarks:
This draft op-ed has gone forward to the President. Please provide
minor edits directly to Aram Bakshian, with a copy to my office,
by 11:00 a.m. Monday, May 23.
Thank you.
Richard G. Darman
Assistant to the President
(x2702)
Response:
No Comment.
(Bakshian)
May 21, 1983
Noon
PRESIDENTIAL OP-ED PIECE FOR WASHINGTON POST
In a matter of hours, the Congress will vote on a question
of vital concern to all Americans. The debate on the
MX Peacekeeper missile, and the whole issue of strategic
modernization, has been on the front pages for months now and may
seem to have reached its saturation point. But, as is too often
the case, the nature of much of the debate has generated far more
heat than light, and made it harder for many sincere citizens to
reach a calm, reasoned decision.
In these final hours before the Congress acts, I want to
state, clearly and directly, what is at stake, and why it is so
important to our country and to the world our children will
inherit from us. Most of us are already familiar with what the
vote will be about. The specific legislative proposal is to
approve flight testing of the MX Peacekeeper missile and the work
needed to base it in existing Minuteman silos. This is the first
essential step toward deployment of 100 Peacekeeper missiles
beginning in 1986, and for the development of a new, small, and
mobile single-warhead ICBM -- all part of a long-overdue
modernization of our aging defense system.
But if the details of the debate are clear enough, its
importance may not be. At stake is the future of arms
reductions -- balanced, verifiable arms reductions that can make
the world of tomorrow a safer place for all the Earth's people.
That is a goal all sensible people share, an issue that cuts
Page 2
across party and philosophical lines and unites us as Americans
and as members of the human family.
When I endorsed the Scowcroft Commission's recommendations
on the MX Peacekeeper and modernization, I did SO because I was
firmly convinced that they balanced the three keys to our
country's present and future safety: modernization, to maintain
state-of-the-art readiness against a much newer Soviet array of
systems; deterrence, to continue to make clear to the Soviets
that aggression on their part would never pay; and progress in
arms reductions to move from a balance of terror toward stable,
peaceful discourse in the competition of ideas.
All three of these elements are crucial to our country's
present and future well-being; they are also interdependent.
Modernization goes hand-in-hand with a credible deterrent; both
are necessary incentives to persuade the Soviets that it is in
their best interest as well as ours to achieve meaningful arms
reductions.
So the vote on the MX concerns far more than one piece of
military hardware. It bears directly on our ability to
strengthen the peace through arms reduction agreements that make
for more security and stability by reducing overall force levels.
The Scowcroft Commission proved that this is not a partisan
issue. Its members, drawn from both parties, from several
previous administrations, and from some of our best technical and
scientific institutions, demonstrated that Americans with widely
differing attitudes can cope with a complex, emotional issue,
Page 3
rise above politics, and achieve a workable, bipartisan
consensus.
The members of the Commission agreed on the need to build
and deploy the MX, not as an engine of destruction, but as a
safeguard for peace; not as a means to fight a war, but as a
deterrent to conflict and an incentive to peaceful negotiation.
These are things we all want.
The question now before us is whether or not the Congress
will join this consensus, a consensus that can unite us in our
common search for ways to protect our country, reduce the risk of
war and, ultimately, reduce the level of nuclear weapons. Such a
consensus is more than desirable; it is crucial to America's
future and to the future of all the civilized values we hold dear
and would protect from mass destruction.
If we can consolidate this consensus now, it can be
sustained from one Administration to the next, from one party to
another, and lay the groundwork for steady progress toward arms
reduction and a more peaceful and secure world. It is this
realization which has caused many Democratic Members of the
Congress who disagree with this Administration on a number of
other issues, to make common cause with us on this one. Only
last week, in these pages, a liberal Democratic Congressman,
Representative Dan Glickman of Kansas, explained why he had
changed his mind and decided to vote in favor of the MX. "To
kill the MX now," he wrote, " may indeed reduce the Soviets'
inclination to 'give' on their giant land-based missiles, which
is the heart of what we want in an arms control agreement. I
Page 4
have come to the conclusion that the basic question is this:
Will the funding for the MX help or hurt our ability to reach an
ultimate reduction in nuclear weapons arsenals? It is a very
close question but, on balance, I believe that we are closer to
an agreement and to a reduction
if we proceed -- at least
initially -- on funding for the missile."
As the Congress reaches the eleventh hour, the choice is
clear: A vote for the MX is a vote for what all of us -- here
and among our friends overseas -- want for our country and for
posterity -- a better chance for peace, for security, for an end
to nuclear horror and a beginning toward arms reductions. In
pursuit of this noble goal, I- will continue. to work closely with
the Congress. But, to succeed, I will need its bipartisan
support. I cannot think of any single issue where it is more
justified, and more vital to the future of mankind.
COMMENTS 5723 TODAY
Document No. 073350CS
WHITE HOUSE STAFFING MEMORANDUM
NOON MONDAY
DATE: May 20, 1983
ACTION/CONCURRENCE/COMMENT DUE BY: MAY 23, 1983
SUBJECT: Report on Infanticide Regulation
ACTION FYI
ACTION FYI
VICE PRESIDENT
GERGEN
MEESE
HARPER
BAKER
JENKINS
DEAVER
MURPHY
STOCKMAN
ROLLINS :
CLARK
WHITTLESEY
DARMAN
P
DSS
WILLIAMSON
DUBERSTEIN
VON DAMM
FELDSTEIN
BRADY/SPEAKES
FIELDING
ROGERS
FULLER
Remarks:
Please provide comments on the attached package and
recommendation provided by the Infanticide Working Group
concerning reissuance of the Infanticide Regulation to
my office by Noon Monday, May 23.
Thank you.
Richard G. Darman
Assistant to the President
(x2702)
Response: This is a good revision.
It. waintain the invential points:
2. 1. National Federal enforment hetline fined on See 504 his of Rehabilitation
Act as the President stated in massage of
April, 1982 to HHS X Justice M.
DEPARTMENT
THE UNDER SECRETARY OF HEALTH AND HUMAN SERVICES
STATE
WASHINGTON, D.C. 20201
USA
May 18, 1983
MEMORANDUM FOR CRAIG FULLER
Pursuant to your instructions, attached is the report of the working
group formed to review the HHS interim final rule published March 7, 1983.
We are recommending publishing a notice of proposed rulemaking which
modifies the interim final regulation somewhat; including an extensive
preamble discussing the issues raised by Judge Gesell; and concluding
with an appendix to the regulation which provides examples of the type
of case to which the regulation is directed.
As you can see in the report, the working group held several formal
sessions and met with representatives of the physicians, hospitals,
handicapped, and prc-life groups in an effort to assure that all concerns
were recognized in our proposed action.
Much discussion surrounded the role of the state agencies in enforce-
ment of Section 504. While recognizing that states should play a
significant role, it was generally concluded that the ultimate responsi-
bility for enforcement of civil rights legislation rests with the Federal
Government. Nevertheless, we are recommending that a notice be sent to
state agencies and that their role be clarified and enhanced.
Finally, the working group and more particularly, the group represent-
ing the handicapped and pro-life contingents felt that the Federal Govern-
ment should utilize all available tools for enforcement, specifically
criminal prosecution where warranted. Accordingly, we are recommending
that a notice be sent to the United States Attorneys alerting them as to
the applicability of Section 504 and the fact that a violation may be a
violation of the criminal provisions of 18 USC 241.
I recommend that the attached notice of proposed rulemaking with
preamble and appendix be published in the Federal Register.
AMM
Attachments:
Tab A - Report of the work group
Tab B - Recommended notice of proposed rulemaking
Tab C - Working group members
Tab D - Attendees at meetings with non-governmental
organizations
REPORT OF THE INFANTICIDE WORKING GROUP
Background
The working group created by memorandum from Craig Fuller to the
Secretary of HHS met on two occasions (see Tab C for list of members).
In addition, a sub-group of the working group led by the Chairman met
with representatives of the health care industry and with groups
representing pro-life positions and the handicapped (see Tab D for a
list).
The results of those discussions and recommendations follow.
The President's April 30, 1982, memorandum instructed the Secretary
of Health and Human Services to inform health care providers of the
applicability of Section 504 to the care and treatment of handicapped
infants. It indicated his decision that existing federal civil rights
statutes afforded protection to handicapped infants and his determina-
tion that they will be "vigorously enforced"
On May 18, 1982, the Department of Health and Human Services notified
approximately 6,800 hospitals which receive federal financial assistance
that it is unlawful under Section 504 to withhold from handicapped infants
nutritional sustenance or medical care required to correct a life threat-
ening condition. (As the President stated in his March 8 Orlando
address: "I have directed the Health and Human Services Department to
make clear to every health care facility in the United States that the
Rehabilitation Act of 1973 protects all handicapped persons against
discrimination based on handicaps, including infants.")
The Department published on March 7, 1983, an interim final rule,
which used Title VI of the Civil Rights Act procedures to make known to
beneficiaries their right to federal protection against discrimination.
In addition, it waived the ten day waiting period before referral to the
Department of Justice for enforcement.
The March 7 rule provided a system for beneficiaries of federally
assisted programs to be informed of their rights and in turn provided
the beneficiaries and the public with a hotline informing the Department
of suspected violations.
The interim rule required each hospital to post a notice in a
"conspicuous place" in the delivery, maternity, and pediatric wards and
in each nursery. The notice gave the hotline number and encouraged
persons who had knowledge of an infant being discriminated against to
call the hotline number.
-3-
This position seemed to be accepted by all parties once understood.
The industry groups were concerned that we were mandating expensive and
useless procedures. Once explained, they concurred with our position.
This position is spelled out in the recommended rule and appendix.
Who should be the Prime Enforcer of Section 504?
Much of the discussion surrounded the question of which entity should
provide enforcement of the prohibition contained in Section 504.
Under the interim final rule and procedures adopted by HHS, HHS
through its regional structure of the Office of Civil Rights was given
responsibilities for initial investigation and enforcement. The states
were also acknowledged to have a role in infant protection under the
various child protection statutes.
The hospital groups would prefer enforcement and investigation to
be done at the local level by a multi-disciplined board (including
representation of handicapped groups) on a facility-by-facility or
regional basis. They believe that individual cases are subject to
considerable subjectivity and therefore require onsite analysis. The
Federal role to them should be one of oversight, on a retroactive basis,
rather than enforcement. Hospital spokesmen cited concern about federal
employees tramping around in hospitals at all hours as a problem. The
pro-life and handicapped groups and the working group feel that such a
review board procedure would do little to prohibit past practices. Even
attorneys for the handicapped felt that a properly constituted board would
be a significant intrusion into hospital operations.
Several members of the working group and of the other groups felt
the states should be the primary enforcers. DOJ put forth such a proposal
and a similar proposal was made by attorneys for the handicapped. Valid
questions do exist about this new role for the Federal Government,
however it was the opinion of the group that on balance, the enforcement
of civil rights statutes is a federal responsibility. States should be
encouraged to exercise their authority, trained in the problem, and
made aware of remedies available to them in order to more fully supplement
the federal capability.
What system should be available to notify OCR of potential violations?
The interim final rule required the posting of the notice in
"conspicuous" places in all the areas of a hospital frequented by infants.
The notice contained the hotline number and urged people to call and
report discrimination. Perhaps more than any other aspect of the
regulatory scheme, this requirement infuriated the hospitals and
particularly the physicians. Comments were made that it created "havoc"
in the hospitals and "destroyed the trust" between the doctor and the
patient's family.
-4-
Without acknowledging any merit in the providers claims, the handi-
capped groups recognized that the postings required under the interim
final rule have had some unintended results. HHS too, reports that members
of the public have misinterpreted the notices and called the hotline with
irrelevant complaints.
All parties appear to recognize that legitimate complaints of the
type of discrimination the notice is intended to prevent come from nurses
working in the various wards.
It is probably advisable to modify the notice requirement and redirect
it towards those most knowledgeable. Such a modification would not diminish
the federal role or reduce protection of newborn infants.
What is the legal basis for HHS enforcement?
HHS has long maintained that payment of Medicare or Medicaid to a
hospital constitutes federal financial assistance (FFA) to the facility
and therefore the facility must meet such requirements as the department
chooses to legally impose. Failure to do SO would result in the loss of
such federal financial assistance. The Americab Hospital Association
maintains that the programs do not constitute FFA to the hospitals and
therefore only hospitals which actually receive some type of grant
(approximately 5% of the facilities) are covered under our March 7
rule. They further believe that the only penalty for failure to comply
would be loss of the specific grant money.
The Department of Justice has not issued an opinion on this issue
and there continues to be some disagreement within DOJ. The working group
was promised a position from DOJ, but it was not forthcoming. Given the
President's statements, both written and oral, the working group has
concluded that the traditional HHS position is preferable.
Because of the potentially limited nature of a threat to withhold
federal financial assistance to prevent or stop an ongoing, life
threatening violation of Section 504, an effective response to life
threatening discrimination against handicapped infants requires not only
a cooperative effort between federal, state, and private agencies, but
also the full utilization of federal civil rights protection. In the
President's memorandum of April 30, 1982, he instructed that he be
informed of the application of existing federal constitutional and
statutory remedies, other than Section 504, to prevent the withholding
of life-saving treatment to handicapped infants.
Several groups representing the handicapped and pro-life views made
strong arguments for the Justice Department to vigorously enforce the
criminal conspiracy provisions of the law.
-5-
Section 241, Title 18 of the United States Code provides that: "If
two or more persons conspire to injure, oppress, threaten, or intimidate
any citizen in the free exercise or enjoyment of any right or privilege
secured to him by the Constitution or laws of the United States They
shall be fined not more than $10,000 or imprisoned not more than ten
years, or both, and if death results, they shall be subject to imprison-
ment for any term of years or for life."
For example, agreement by parents and hospital personnel not to treat
a congenital anomaly incompatible with life and amenable to surgical
correction in a child with Downs syndrome may constitute conspiracy and
therefore be a violation of Section 241.
Recommendations
A.
It is recommended that the Department of Health and Human Services:
1. Issue a Notice of Proposed Rulemaking (see Tab B) which
restates the March 7, 1983, interim final rule with the
following modifications:
(a) the requirement that the notice be posted "in each
delivery ward, each maternity ward, each pediatric ward,
and each nursery, including each intensive care nursery"
be changed to require that the notice be posted in the
nurses' station having responsibility for such sections
in the hospital;
(b) the notice to be posted be no smaller than 8½ by 11
inches (the notices distributed by the Department will
in fact be 8½½ by 11 inches);
(c) require hospital personnel to identify on the space
provided on the notice the state child protection
agency where child neglect or abuse violations can be
reported, rather than simply providing this as an option;
(d) the proposed regulation be published with an appendix
which further clarifies issues raised in discussions
with outside groups and in Judge Gesell's opinion since
such an appendix would provide more authoritative
guidance and would be accorded greater weight by a
reviewing court;
(e) that the preamble published with the proposed regulation
further clarify issues raised in the litigation and
specifically request comments on a number of questions
raised by Judge Gesell and others.
-6-
2. In order to clarify the role of State child welfare agencies
and to encourage their involvement in protecting the rights
of handicapped infants:
(a) send a notice, similar to the May 1982 Notice to Health
Care Providers, to State child protection agencies to
clarify their responsibilities as recipients of federal
financial assistance under Section 504:
(b) develop technical and other appropriate assistance to
State and private child protection agencies consistent
with their Section 504 responsibilities and communicate
the assistance to those agencies.
B.
It is recommended that the Department of Justice notify United
States Attorneys that a life threatening violation of Section 504
may constitute a violation of federal criminal law prohibiting
conspiracy against rights of citizens (18 U.S.C. 241) and that
they be prepared to institute timely proceedings as necessary
regarding an ongoing or past life threatening violation of
Section 504.
Supplementary Information: The President's directive of
April 30, 1982, and the HHS Office for Civil Rights "Notice
to Health Care Providers" of May 18, 1982, reminded recipients
of federal financial assistance of the applicability of
oction 504 of the Renabilitation Act of 1973. Section 504
provides: "No otherwise qualified handicapped individual
snall, solely by reason of his handicap, be excluded from
participation in, be denied the benefits of, or be subjected
to discrimination under any program or activity receiving
federal financial assistance. "
The Notice to Health Care Providers explained what is already
clear from the language of Section 504 and the implementing
regulations (45 CFR Part 84) : The discriminatory failure of
a federally assisted health care provider to feed a handicapped
infant, or to provide medical treatment essential to correct a
life-threatening condition, constitutes a violation of Section 504.
Section 504 requires that health services be provided to the
nandicapped "on a basis of equality with those not handicapped,"
Doe V. Colautti, 592 F. 2d 704, 709 (3d Cir. 1979), in order to
assure "the evenhanded treatment of qualified handicapped persons. #
Southeastern Community College V. Davis, 442 U.S. 397, 410 (1979).
- 2 -
Section 504 is in essence an equal protection, non-discrimination
standard. Congress expressly intended Section 504 to prohibit
discrimination based on handicap in the same way that Title VI
of the Civil Rights Act prohibits discrimination based on race.
Programs or activities receiving federal financial assistance
may not deny a benefit or service on grounds of a person's handi-
cap, just as they may not deny a benefit or service on grounds of
a person's race.
The Rehabilitation Act of 1973 defines a "handicapped individual"
as "any person who (i) has a physical or mental impairment which
substantially limits one or more of such person's major life
activities, ... or (iii) is regarded as having such an impairment." "
29 U.S.C. 706 (7) (B). Thus it is clear that a handicapped infant
is an "individual" within the protection of the statute and is
a "person" within the protection of the regulation. Nothing
in the plain language of Section 504 or its legislative history
provides a basis for excluding infants from the statutory coverage
of "individuals". It is equally clear, however, that the great
majority of seriously ill children who require acute medical
attention are not included in the term handicapped persons as
used in Section 504. For example, a premature or otherwise low
birth weight infant would not on that basis alone be considered
a handicapped person for purposes of Section 504 even though he
may require acute medical care.
- 3 -
The definition of a qualified handicapped person was clarified
by the Supreme Court in Southeastern Community College V. Davis,
442 U.S. 397 (1979). In that case the Court addressed the
question of whether a nursing school was prohibited by Section 504
from imposing certain physical qualifications for admission to
its clinical training program. Noting that Section 504 pronibits
discrimination on the basis of handicap against otherwise
qualified handicapped individuals, the Court focused on the
question of whether the plaintiff was otherwise qualified. It
concluded that she could benefit from the program without
fundamental alteration of the program. Id. at 409-410. As
applied in the context of health care to handicapped infants,
Section 504 would hold that where an infant would not benefit
medically from a particular treatment, the infant would not be
"qualified" to receive the treatment; thus, its denial would
not violate Section 504.
Section 504 does not compel medical personnel to attempt to
perform impossible or futile acts or therapies. Thus, Section 504
does not require the imposition of futile therapies which merely
temporarily prolong the process of dying of an infant born
terminally ill, such as a child born with anencephaly or
intra-cranial bleeding. Such medical decisions, by medical
- 4 -
personnel and parents, concerning whether to treat, and if so,
what form the treatment should take, are outside the scope of
Section 504. The Department recognizes that reasonable medical
judgements can differ when evaluating these difficult, individual
cases.
The Department's existing regulations prohibit a recipient in
providing any aid, benefit, or service from denying a qualified
handicapped person "the opportunity to participate in or benefit
from the aid, benefit, or service." 45 C.F.R. 84.4 (b) (1) (i).
The regulations also prohibit a recipient from affording a
qualified handicapped person "an opportunity to participate in
or benefit from the aid, benefit, or service that is not equal
to that afforded others." 45 C.F.R. 84.4 (b) (1) (ii) (emphasis
supplied).
Recognizing that Section 504 protects only those infants who
are able to benefit from treatment, the Department's May 18,
1982 Notice to Health Care Providers explained that a violation
of Section 504 occurs when the treatment is withheld because of
the existence of a handicap and the handicap does not render
the treatment medically contraindicated.
- 5 -
Thus, Section 504 simply preserves the decision-making process
customarily undertaken by physicians in any treatment decision:
will the treatment be medically beneficial to the patient and
are those benefits outweighed by any medical risk associated
with the treatment? It is only when non-medical considerations,
such as subjective judgements that an unrelated handicap makes
a person's life not worth living, are interjected in the
decision-making process that the Section 504 concerns arise.
The judgement Section 504 requires of a physician is a
medical judgement concerning what medical treatment shall be
provided an individual. Not all judgements made by a health
care provider, however, are medical judgements. For example,
a judgement not to treat a black infant because of the infant's
race is not a medical judgement. A judgement not to remove a
stomach block or repair a heart of a Down's Syndrome infant
because the infant suffers the handicap of Down's Syndrome is
likewise not a medical judgement.
The decision to forego medical treatment of a correctable
life-threatening defect because an infant also suffers from a
permanent, irremediable handicap that is not life-threatening,
such as mental retardation, is a violation of Section 504. In
this context, Section 504 provides that usual and customary
- 6 -
medical care afforded to non-handicapped infants not be denied
to handicapped infants when they would benefit from such
treatment. Similarly, where a course of medical care is usual
and customary to correct or ameliorate a life impairing
condition among a particular class of patients, for example.
such as infants suffering from meningomyelocele (spina bifida),
such beneficial care may not be withheld from an individual
infant because of a subjective judgement that such infants as
a class possess an insufficient quality. of life.
While these are often difficult decisions to make, as well as
to review, the standard of customary medical care is not one
unfamiliar in the medical community and the Department
appreciates the standard set forth in the recent Report of the
President's Commission for the Study of Ethical Problems in
Medicine and Biomedical and Behavioral Research, entitled,
"Deciding to Forego Life-Sustaining Treatment."
The Commission concluded that "a very restrictive standard is
appropriate" in decisions regarding the treatment of handicapped
infants and the Department requests comments on the following
statement of the Commission:
- 7 -
Though inevitably somewhat subjective and imprecise in
actual application, the concept of "benefit" excludes
honoring idiosyncratic views that might be allowed if a
person were deciding about his or her own treatment
As in all surrogate decision-making, the surrogate is
obligated to try to evaluate benefits and burdens from
the infant's own perspective. The Commission believes
that the handicaps of Down Syndrome, for example, are
not in themselves of this magnitude and do not justify
failing to provide medically proven treatment, such as
surgical correction of a blocked intestinal tract.
This is a very strict standard in that it excludes
consideration of the negative effects of an impaired
child's life on other persons, including parents, siblings,
and society. Although abiding by this standard may be
difficult in specific cases, it is all too easy to
undervalue the lives of handicapped infants, the
Commission finds it imperative to counteract this by
treating them no less vigorously than their healthy
peers or than older children with similar handicaps
would be treated.
1
Events of the past several years suggest that handicapped
infants have died from denial of food in federally assisted
programs. The full extent of discriminatory and life-threatening
practices toward handicapped infants is not yet known, but the
Secretary believes that for even a single infant to die due
to lack of an adequate notice and complaint procedure is
unacceptable.
There is a great deal of evidence documenting that the "very
strict standard" advocated by the President's Commission and
the requirements of Section 504 are not being uniformly
followed and that medically indicated treatment is sometimes
- 8 -
withheld from infants with congenital anomalies on the basis
of their handicaps. For example, a 1973 article by Doctors
Duff and Campbell of the Yale-New Haven Hospital documenting
that of 299 consecutive deaths occurring in that special care
nursery, 43 (14 percent) were related to withholding treatment.
289 N. Engl. J. Med. 890. The following was among the cases
documented:
An infant with Down's Syndrome and-intestinal atresia,
like the much publicized one at Johns Hopkins Hospital,
was not treated-because his parents thought the surgery
was wrong for their baby and themselves. He died several
days after birth. Id. at 891.
-
The Johns Hopkins case became the subject of a documentary
produced by the Joseph P. Kennedy Foundation, excerpts from
which were shown as part of the "Death in the Nursery" documentary
series presented by a Boston television station in February 1983.
The facts of this particular case cited by Duff and Campbell
were also much like the 1982 Bloomington, Indiana case cited
by President Reagan in his statement of April 30, 1982, in
which an infant with Down's Syndrome and a correctible
esophageal atresia was allowed to die.
- 9 -
Another specific case investigated by the HHS Office for Civil
Rights similar to the Yale-New Haven, Johns Hopkins, and
Bloomington cases related to a 1979 death of an infant with
Down's Syndrome and an intestinal obstruction at the
Kapiolani-Children's Medical Center in Honclulu, Hawaii. As
a resolution to the complaint, HHS and the hospital, in May
of 1980, agreed to an an amendment to the hospital's written
consent procedures to assure that cases involving a lack of
parental consent to medically indicated"treatment for handicapped
infants be reported to the State child protective services
agency in the same manner as similar cases involving non-
handicapped children.
In addition to the four documented cases, Yale-New Haven, Johns
Hopkins, Kapiolani, and Bloomington, and the other cases cited
by Duff and Campbell, there is persuasive evidence that cases
involving discriminatory denial of care are not unique. A 1977
article, "Ethical Issues in Pediatric Surgery," 60 Pediatrics
588, reported the results of a survey of 400 members of the
Surgical Section of the American Academy of Pediatrics and an
additional 308 chairpersons of teaching departments of
pediatrics and chiefs of divisions of neonatology and genetics.
in departments of pediatrics. Responses were received from 267
- 10 -
of the former group (66.8%) and 190 of the latter (61.7%).
Id. at 588-9. Responses were anonymous. Among the results
of the survey were:
-- 76.8% of the pediatric surgeons and 59.5% of the
pediatricians said they would "acquiesce in parents'
decision to refuse consent for surgery in a newborn
with intestinal atresia if the infant also had
Down's Synrome." Id. at 590.
-- 23.6% of pediatric surgeons and 13.2% of pediatricians
would encourage parents to refuse consent for treatment
of a newborn with intestinal atresia and Down's
Syndrome. Only 3.4% of pediatric surgeons and 15.5%
of pediatricians would get a court order directing
surgery if the parents refused. Id. at 591-2.
-- 63.3% of the pediatric surgeons and 42.6% of the
pediatricians said in cases of infants with duodenal
atresia and Down's Syndrome, where they "accept
parental withholding of lifesaving surgery," they
would also "stop all supportive treatment including
intravenous fluids and nasal gastric suction."
Id. at 592-3.
-- 62% of all respondents who believe that children with
Down's Syndrome "are capable of being useful and
bringing love and happiness into the home" would
nevertheless acquiesce in parents' decisions not
to allow surgery for the atresia. Only 7% who SO
believe indicate that they would go to court to
require surgery. Id. at 595.
These data strongly suggest that instances, such as occurred in
Bloomington, Indiana in 1982, in which infants are denied
life-sustaining, medically indicated treatment solely on the
basis of their handicap cannot be dismissed as isolated
events.
- 11 -
For purposes of applying Section 504, it is important to note
that only 7.9% of Surgical Section members, and only 2.6% of
other pediatricians, would acquiesce in parental refusal to
treat intestinal atresia in an infant with no other anomaly.
Their acquiescence in non-treatment of Down's children is
apparently because of the handicap represented by Down's
Syndrome. A significant number of Surgical Section members
indicated that they would do considerably more than "acquiesce" in
parental decisions not to treat: 23.6% said that, given parents
who are indecisive about treatment of a Down's Syndrome infant
with intestinal atresia, they would encourage the parents not
to consent. Only 3.4% of Surgical Section members said they
would get a court order if parents refused consent in such
situations. Moreover, the underlying rationale of the surgeons'
responses appears not to be so much a deference to parental
judgement as a personal view that Down's Syndrome children
are not worth having. A large majority (78.3% of surgeons,
88.4% of others) said they would get a court order directing
surgery on a young child with a treatable malignant tumor
whose parents refused consent out of belief in faith healing.
But when asked, "If you were the parent of a newborn infant
with Down's Syndrome and intestinal obstruction, would you
consent to intestinal surgery?", only 27% of surgeons answered
Yes. Other pediatricians responded 53.7% Yes.