Down Syndrome (DS) is a commonly occurring chromosomal abnormality. The incidence increases with advancing maternal age over 35 years. Over the last three decades, tremendous progress has been made in the medical and surgical treatment of these infants. Nationally, a great deal of resources are allocated to DS infants to improve their growth and development. Yet, the perception remains that the DS infant is still not openly accepted by parents and society, as illustrated by the presented cases. This lack of acceptance creates many complex ethical challenges in treating such babies, starting with fetal diagnosis of the disorder in the womb and moving through early stages after the birth of the baby. We argue that health professionals have the responsibility to help make public attitudes more accepting of Down Syndrome. Professionals should encourage social and community involvement of these children. The National Association for Down Syndrome should be contacted periodically to promote activities to enhance public awareness. To the end of greater acceptance, we suggest a ritual at birth that might improve the acceptance of the DS child into the family and the community and hence help improve social attitudes toward Down Syndrome.

Nationwide, almost 11% of women abuse drugs during their pregnancy. In some communities, these numbers are as high as 25–30%. Drug abuse is not limited to the poor or to African Americans, but is seen among affluent and white Americans as well. It is widespread, irrespective of race or social class. Annually, nearly 375,000 infants are exposed to drugs in America. Because of the terrible suffering caused by these births, and the conflicts caregivers experience in the treatment of these infants, Trollope's quote is very apropos. Although caregivers have good motives in trying to rescue these babies and helping place them in a nurturing environment, despair about this objective is always close to the surface.

We appreciated the important commentary provided by Michelle Oberman on our paper, “Discontinuing Life Support in an Infant of a Drug-Addicted Mother: Whose Decision Is It?” (CQ Vol. 6, No. 1). For the most part we agree with Oberman's analysis of the issues, but there are seven points of variance, either of conception, emphasis, or accuracy. We wish to clarify these and welcome the chance her commentary provided to offer aspects of the social situation surrounding the case we presented.