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Earlier, in April 1982, Koop had become involved in a medical, ethical, and legal controversy over the denial of medical treatment to babies born with disabling birth defects, the so-called "Baby Doe" controversy. Over the next two years, media reports of similar cases in which parents chose to withhold medical treatment from their severely disabled newborns, including cases of children with spina bifida (a defective closure of the spinal cord, leading to paralysis of varying degree) such as the one referred to in this letter, led the U.S. Congress to amend federal child abuse laws to include such denial of treatment.