7. J. is 11 years old, is affected with Down's syndrome, and suffers from mental retardation. He has never lived at home and has been institutionalized since birth. He is in a home for 19 multiply...

Extracted text: 7. J. is 11 years old, is affected with Down's syndrome, and suffers from mental retardation. He has never lived at home and has been institutionalized since birth. He is in a home for 19 multiply handicapped children and is attending a special school. He is able to write his name, has good motor and manual 84 1/PRINCIPLES OF HEALTH CARE ETHICS skills, can dress himself, is toilet trained, can converse reasonably well, and can participate in school and Boy Scoutactivities. It has been recommended that he be placed in the county's sheltered workshop following his education. This means that he can be occupied in some gainful employment. When J. was six, a pediatric cardiologist made a preliminary diagnosis of a ventricular septal defect, a hole between the two chambers of the heart that elevates the pulmonary artery pressure. The pediatrician recommended cardiac catheterization to define the exact nature of the problem. The parents agreed. The tests showed a condition that, if untreated, generally leads to an average life expectancy of 30 years. About 25 percent of people with this con- dition die suddenly; the rest deteriorate slowly. Untreated children cannot run and play. The pediatrician recommended corrective surgery with a risk of death placed at 3 to 5 percent. He noted that he did not recommend the surgery for those with lower IQs, since little would be gained. J's parents refused because they do not want J. to outlive them. They be lieved that care for the disabled in the United States is terrible. They also believed that J. would be a burden to their nondisabled children. Is it ethical to not recommend the operation for those with low IQs? Is the physician using an unethical quality-of-life norm? Are the motives of Is parents consistent with their obligations as surrogates? Note that 1. has never lived at home and he might be a burden on the other students when he gets older.