This doesn't sound particularly extreme to me. 22 weeks is incredibly early. Not keeping someone alive when it most likely causes the person extreme discomfort and the chances for survival and significant improvement are very low isn't euthanasia.
There is a more troublesome dilemma I read about recently. Here is the situation: a pregnant woman develops a complication around 22-23 weeks which makes it extremely likely that the baby will have to be born within the next few weeks. The chances of a 24-25 week premature baby are about 50/50 for survival, 50/50 for serious diability in case of survival. The parents are told that they won't have an option of letting the baby expire if the baby is born after 24 weeks so they opt for an abortion of an otherwise wanted pregnancy before 24 weeks in order to avoid the high chance of having a disabled child.
>>chances for survival and significant improvement are very low I realize that they're practically non-existent, but I still feel libertarian on this one, that parents should be given a choice in the matter.
The other case is strange - how could they not have the option to refuse care? Or does that fall under some child neglect laws or something?
Realistically, doctors will deny many requests for care of a sick person coming from the person's family if the doctors consider the requested measures unreasonable.
The other case, if I remember correctly, is also from UK. I'm not sure how it works technically, but yes, it's the case when doctors can override parents if they consider it in the best interest of the child, and 25% chance of growing into a healthy child can be considered worth it.
in the UK, with socialized medicine, and the state taking care of the disabled along with it, I can see how they'd have a right to make the decision, I guess.
I have a problem with "... they are owed care.". I guess I am even more libertarian on this one than you are. I think that no one is owed care, much less an unlimited amount of care. We just do not have enough resources for that. A care for such baby would most likely be futile and will deny care to several other babies who are likely to survive and benefit from that care. The same goes for non-baby cases. Of course, if the parents are very rich and can pay for such care themselves, they should be given an oportunity (despite of ethical arguments against it motivated by the baby's "sufferings," since I do not beleive that babies can "suffer" -- they experience pain but not psychological "suffering").
I object to the way you use quotes here. The question here is not "phychological suffering" vs "some other kind of suffering".
The issue is "pain without suffering", where "suffering" is a "psychological" phenomena, whereas "pain" is just a physiological response.
A physiological response that we call "pain" is a stimulation of neurons in a sensory cortex. A psychological phenomena that we call "suffering" is stimulation of neurons in higher-order cortex, especially of the kind that causes lasting changes in that cortex.
It's been proven that even full term infants do not have the wiring from the sensory cortex to the higher-order cortex in place for several months. Hence, any "pain" that experience (for example, circumsision) does not cause "suffering" and has no impact on the future psychological being that develops out of that infant.
Well, first of all, I believe in euthanasia - but in the case of adults who *want* it (or would want it if they were capable of thinking for themselves, as in the case of PVS).
As for the case of the babies - if you have scarce resource allocation, and spending effort trying to save the babies would prevent you from, say, saving someone else's life, then you have a choice to make, and I can see either side (trying to save the baby or giving up on it) as being justified - especially if you let the mother and doctor make a rational decision together.
However, if you have (effectively) unlimited resources, then the only downside of trying to save the preemie is the "pain to the premie" and, given a choice between instant, painless death, and tremendous pain with a 1% chance of survival, a value judgment has to be made, and again, I can see both sides being justified.
I guess what I'm saying is I don't think there should be a "general rule" except if it's a clear economic (resource-wise) advantage to give up on the babies.
I agree with your conclusion (whoa! freaky! :), that's the part that really outrages me. Have you ever seen a show called "Dinosaurs"? The epi when grandma was supposed to toddle off to the tar pits?
I never saw that episode (actually, I'm not sure if I ever saw a whole episode), but there was a Star Trek: The Next Generation episode in which Mrs. Troi fell in love with a guy who was supposed to commit suicide on his 60th birthday...dunno if that's similar :p
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
( ... )
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.
When all's said and done and argued, it feels like you just tried to start a flame war, because the recommendation in fact says:
"The Nuffield Council, which considers ethical questions raised by advances in medical care, also recommended that babies born between 22 and 23 weeks should not usually receive intensive care unless parents make a request and doctors agree."
And the article you yourself link to specifically says:
"In guidelines issued to help doctors and parents make difficult decisions about the care of extremely premature infants, the report recommended parents of babies born after 23 should be consulted and have the final say in whether intensive care is given to their baby."
How is "should be consulted" at all like "and the parents should not even be given a choice about it?"
I guess I'll know in the future to not trust your interpretation of things and actually read the article for myself.
I think you are being a bit unfair. There is nothing to flame about here. Maybe the costs, possibly, but they weren't initially brought up by bublik64. You are citing the recommendations for 22-23 weekers. She and some others are bothered by the guidelines that say no interventions for babies born before 22 weeks. As I mentioned a few times above, I think the reason for their discomfort is that 22 weeks sounds not that far from, say, 24 weeks, when chances of survival are about 50%. In fact, the difference between 22 and 24 weeks is significant and crucial. I admit I invited moretp into the discussion in part because bublik64 wouldn't take my word for it.
I don't know,she didn't mention anything about the particularities of the number of weeks. From what I read her argument to be, if the guidelines said "less than 10 weeks," she'd have the same issue.
Comments 109
There is a more troublesome dilemma I read about recently. Here is the situation: a pregnant woman develops a complication around 22-23 weeks which makes it extremely likely that the baby will have to be born within the next few weeks. The chances of a 24-25 week premature baby are about 50/50 for survival, 50/50 for serious diability in case of survival. The parents are told that they won't have an option of letting the baby expire if the baby is born after 24 weeks so they opt for an abortion of an otherwise wanted pregnancy before 24 weeks in order to avoid the high chance of having a disabled child.
Reply
I realize that they're practically non-existent, but I still feel libertarian on this one, that parents should be given a choice in the matter.
The other case is strange - how could they not have the option to refuse care? Or does that fall under some child neglect laws or something?
Reply
The other case, if I remember correctly, is also from UK. I'm not sure how it works technically, but yes, it's the case when doctors can override parents if they consider it in the best interest of the child, and 25% chance of growing into a healthy child can be considered worth it.
Reply
Reply
Reply
Reply
The issue is "pain without suffering", where "suffering" is a "psychological" phenomena, whereas "pain" is just a physiological response.
A physiological response that we call "pain" is a stimulation of neurons in a sensory cortex. A psychological phenomena that we call "suffering" is stimulation of neurons in higher-order cortex, especially of the kind that causes lasting changes in that cortex.
It's been proven that even full term infants do not have the wiring from the sensory cortex to the higher-order cortex in place for several months. Hence, any "pain" that experience (for example, circumsision) does not cause "suffering" and has no impact on the future psychological being that develops out of that infant.
Reply
I haven't seen any such research and won't take your word for it, especially the interpretation.
Reply
As for the case of the babies - if you have scarce resource allocation, and spending effort trying to save the babies would prevent you from, say, saving someone else's life, then you have a choice to make, and I can see either side (trying to save the baby or giving up on it) as being justified - especially if you let the mother and doctor make a rational decision together.
However, if you have (effectively) unlimited resources, then the only downside of trying to save the preemie is the "pain to the premie" and, given a choice between instant, painless death, and tremendous pain with a 1% chance of survival, a value judgment has to be made, and again, I can see both sides being justified.
I guess what I'm saying is I don't think there should be a "general rule" except if it's a clear economic (resource-wise) advantage to give up on the babies.
Reply
Reply
Reply
Reply
Reply
Reply
Reply
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.
Reply
"The Nuffield Council, which considers ethical questions raised by advances in medical care, also recommended that babies born between 22 and 23 weeks should not usually receive intensive care unless parents make a request and doctors agree."
http://society.guardian.co.uk/health/news/0,,1948464,00.html
Reply
"In guidelines issued to help doctors and parents make difficult decisions about the care of extremely premature infants, the report recommended parents of babies born after 23 should be consulted and have the final say in whether intensive care is given to their baby."
How is "should be consulted" at all like "and the parents should not even be given a choice about it?"
I guess I'll know in the future to not trust your interpretation of things and actually read the article for myself.
Reply
Reply
Reply
Leave a comment