The cut off in many US hospitals is actually 24 weeks. This is not a random number - it's based on the outcome statistics. It can be interpreted as "enough" 24-weekers are doing well so as to try and save them. 22 weeks is clearly a no go - there is simply no lung tissue to sustain growing and living. Obviously, it's the 23-weekers, who are the most contraversial group of kids - after all, woman's dates could be wrong, and what if the baby is really a 24-weeker. It is in these cases families are counceled extensively by neonatologists and familiy's wishes are often taken into the account. I work in the neonatal ICU in California. I have heard about those miracle babies, who came out at 23 weeks and now they are perfectly healthy adults - I've just never seen one in real life. Usually, you can predict that after ressuscitating and stabilizing a 23-weeker, you'd sign off, come back the next day, and inevitably find the baby on high frequency ventilation (meaning you've maxed out on respiratory support), to find out that the baby has a massive intraventricular hemarhage with midline shift (meaning basically there is a giant bruise and a pool of blood instead of a brain), with potassium of 8 or 10 (meaning the heart is going to go into a V-tach at any moment). Many physicians think that this IS child abuse, and many refuse to go through with ressuscitation.
There is something, though, that makes it almost bearable. Giving an infant this chance to proove, or rather disproove, himself, can make a huge difference and help the family in their grief process. Not having to rely on someone's word and seeing the baby rapidly detiriorate with their own eyes, may make this death more acceptable to the parents and speed up the healing process.
I agree that the second example is way more tricky. Those parents must've felt VERY strongly about only getting themselves a perfect child. They could've gone to 28 weeks and gotten themselves a decent kiddo.
I also want to mention that you can't have different standards of care for rich and poor people (i.e. only resuscitating preemies whose parents can pay the bill). I think someone brought it up in comments, and it's nonsence.
I've been wondering about uncertain dating of some pregnancies. Have you seen any cases of extreme prematurity when the mother's dates weren't well-known at all? It should be possible to make a fairly good determination based on the baby's development, is that correct?
Yes, it's called Ballard scale. Whenever a newborn seems to act not as expected for gestational age (lungs, skin etc), you "Ballard" them, and this is what you use later on.
>>Giving an infant this chance to proove, or rather disproove, himself, can make a huge difference and help the family in their grief process.
As I think I mentioned above, that seems to me the main problem with a blanket rule like that - someone saying, "it's too much work and resources to save your baby, so we won't bother trying even the basics". That just seems so cruel to me, although I am not sure whether I as such a parent would want to see it. I'd want the option, though.
I think you are seeing the situation as being more complicated than it really is. Babies born at 22 weeks are not viable with the current technology. There are no "basics" that can keep them alive, only enormous efforts and heavy interventions, with poor long-term results. I asked mearah above if she would be similarly bothered by guidelines which listed a smaller number like 20 weeks or even less. The problem is that 22 weeks sounds close to 24, but there is a significant developmental difference.
Maybe I am. From what I understood in the article, the chances are very low, but not zero, and you have mentioned errors in dating, too, so my objection is to the blanket decision w/o allowance for doctor and parental wishes for even the simplest interventions. Human biology is varied enough to make for allowing exceptions be necessary.
I hope the rule doesn't apply when the dates are uncertain, but I would guess that gestational age can be determined rather easily by examining a preemie. And again, I doubt simple interventions would make any positive difference.
The fact that the rule is based on this one fact - assumed age - and no influence is given to the doctor familiar with the case, or that parents are not given a chance to convince themselves of it, is what's bothersome to me. That seems just needlessly cruel to everyone involved.
It's not a law, it's a guideline from an ethics council. If a doctor doubts the assumed age, I'm sure he is free to act on that doubt. It seems cruel to me to give parents false hope and to subject preemies to futile invasive treatments.
You could also view it as closure, and also an easy way for some hospital administrator to make decisions based on bottom lines and ignore humans. I don't think that such blanket pronouncements ought to be made - the technology could change quickly, but bureaucratic rules usually don't.
Again, it's not a bureaucratic rule, it's an ethics guideline. If there is a significant change in technology, new guidelines will be issued. If some research hospital suddenly developed appropriate technology to help 22 week preemies, the doctors at that hospital would be free to ignore the guideline. The news of the novel technology would spread fast, too. But technology actually doesn't change quickly, especially when we are up against such significant challenges.
I am not sure why the discussion of expense enters into this either. I doubt that it figured in Council on Bioethics reasoning at all. They are allowing the doctors to say, "We don't think it's ethical of us to provide your baby this treatment. We'd be fooling you if we said it works, and it would make your baby suffer needlessly."
"it's too much work and resources to save your baby, so we won't bother trying even the basics"
Actually, you can't try "just the basics". What if the baby makes it, and you weren't agressive with your treatment from the start? All the time waisted when you could be "treating". You only get to pick and choose interventions when you are withdrawing support in preparations for letting go - stop medications, stop respiratory support, but live morphine drip to decrease pain. Otherwise, you have to do the whole nine yards from the get go.
On another point, can healthy adults born at 23 weeks currently exist even in principle? That would mean a 23-week baby survived some 20 years ago. Did that ever happen back then?
There is something, though, that makes it almost bearable. Giving an infant this chance to proove, or rather disproove, himself, can make a huge difference and help the family in their grief process. Not having to rely on someone's word and seeing the baby rapidly detiriorate with their own eyes, may make this death more acceptable to the parents and speed up the healing process.
I agree that the second example is way more tricky. Those parents must've felt VERY strongly about only getting themselves a perfect child. They could've gone to 28 weeks and gotten themselves a decent kiddo.
I also want to mention that you can't have different standards of care for rich and poor people (i.e. only resuscitating preemies whose parents can pay the bill). I think someone brought it up in comments, and it's nonsence.
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As I think I mentioned above, that seems to me the main problem with a blanket rule like that - someone saying, "it's too much work and resources to save your baby, so we won't bother trying even the basics". That just seems so cruel to me, although I am not sure whether I as such a parent would want to see it. I'd want the option, though.
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I am not sure why the discussion of expense enters into this either. I doubt that it figured in Council on Bioethics reasoning at all. They are allowing the doctors to say, "We don't think it's ethical of us to provide your baby this treatment. We'd be fooling you if we said it works, and it would make your baby suffer needlessly."
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Actually, you can't try "just the basics". What if the baby makes it, and you weren't agressive with your treatment from the start? All the time waisted when you could be "treating". You only get to pick and choose interventions when you are withdrawing support in preparations for letting go - stop medications, stop respiratory support, but live morphine drip to decrease pain. Otherwise, you have to do the whole nine yards from the get go.
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Why can you have a different standard of living, education, sanitation, security, entertainment, etc, but not healthcare?
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