To the Editor.—
The article by Walker et al1 supports an idea that is becoming commonplace in the medical literature: preserving the lives of certain segments of the population (in this case very low-birth-weight babies) may not be worthwhile, not because we are inflicting pain and suffering on them by our treatments, but because they may constitute a net fiscal burden on society. These authors are even more explicit than most, using a cost-benefit analysis that compares the costs of neonatal intensive care and future medical and educational services to an infant's "expected lifetime earnings" to determine a baby's net worth.
Fertility Choice in a Life Cycle Model with Idiosyncratic Uninsurable Earnings Risk