England: Expert tells doctors: let youngest premature babies die

[mnmod]

BRITAIN’S top medical ethics expert has urged doctors to let the most premature babies die, with treatment offered only in exceptional cases.

Baroness Warnock believes Britain should follow Holland in setting an age limit below which babies would not routinely be resuscitated.

She says this would prevent doctors competing for the “triumph” of keeping babies alive at increasingly young ages even though they may not survive in the long term or may be left severely disabled.

Warnock’s comments were backed in part by Britain’s most senior paediatrician, who said the setting of a lower limit should be considered.

In Holland, doctors do not routinely administer intensive care to babies born before 25 weeks of pregnancy. The Nuffield Council on Bioethics, a medical think tank, is considering proposing similar guidelines in Britain. It is consulting doctors, nurses and parents about setting a 24-week limit.

Warnock, who helped frame laws on embryo research and fertility treatment, supports setting an age limit, with exceptions for babies who show they have a strong chance of living to become healthy children.

“Some doctors and nurses get competitive about the triumph of keeping these tiny, premature, babies alive,” she said. “It would be better to set a minimum age than to have no form of scrutiny or regulation. Below a certain age of gestation no baby should be kept going without very thorough scrutiny of what the prognosis for that baby is.”

Although most doctors are opposed to an age limit, Sir Alan Craft, president of the Royal College of Paediatrics and Child Health, said it was a legitimate option to consider. “One possible course of action would be not to intervene with any 23-week-old babies unless they breathe completely and spontaneously themselves,” he said.

Craft, speaking in a personal capacity, argues that, as it is not possible to tell which babies born at 23 weeks or less will survive, doctors are forced to consider resuscitating all of them, although the majority have no chance of living.

Once doctors have started assisting these babies, he says, parents find it difficult to agree to treatment being withdrawn, even though it is of no help.

The Nuffield council is investigating the costs of raising the disabled children that premature babies often become as well as the expense of intensive care in neonatal units.

A study of the most premature babies showed most went on to suffer disabilities. The EPICure study of babies born at 25 weeks or less, led by researchers at Nottingham University, found that, by the age of six, only 20% of surviving children had no disabilities; 22% had severe disabilities, including cerebral palsy; while 34% had milder problems such as a squint.

In addition, it found that only 11% of all babies born at 23 weeks survived. Since the study began, however, care has improved and the figure is believed to be closer to 20%.

Bliss, the premature baby charity, says about 50 babies born at 23 weeks survive every year and it would be wrong to deny them the chance to live.

Bonnie Green, head of external relations, said: “We would be very unhappy. It is expensive to keep adults who may not pull through in intensive care but, in their case, we do not say ‘let’s use the money for something else’.”

[sui generis]

1. I'm on the "let nature take its course side"

of the debate.

Just because you can help an early preemie "survive" doesn't mean you should. But most of all, I believe that each case has its own unique factors. As with laws for any medical decision, you serve no one well when you make blanket laws and then try to apply them to specific cases.

[mnmod]

2. But this is not taking things on a 'case by case' basis..

My wife was with her Grandfather when he was passing and there came a time when the Doctor asked her if he should stop trying (my wife was the only one fluent in English), immediately my wife said no to keep trying (at first she could not bear to ask her grandmother that question). The second time they asked she asked and they together gave up.

this is a case of doctors saying that if a baby is born in the second trimester that recitation should not be attempted. Despite the fact that 1/10 kids born before 24 weeks lives and about 70% of them end up if not in prefect health, healthy enough to lead full lives..

How do we answer someone who say that they saw this coming 20 years ago?

[bleedingheart]

11. I am with you

what was considered a miscarriage 40 years ago ends up being a 4-5 month healthcare odessey that costs hundreds of thousands of dollars that sometimes the parents don't have and some of those babies end up having such severe problems.

[DemExpat]

14. I join you with this view.

DemEx

[Warpy]

3. I hate to see it rigidly limited to the number of weeks

but rather to the fetal stage of development. Yes, we can save a few infants who are born weighing less than 32 ounces, but are the heroics worth it to anyone but the parents? This is a really tough question to ask since there's such a strong cultural value in rooting for the underdog and in defying the odds on hopeless cases. We know that underdevloped infants can be saved but will generally face a lot of problems in later life, although there are rare exceptions.

At what point do we go with the statistics? At what point do the cold facts of figuring the odds trump the passion that parents of premature infants have for their offspring to survive? At what point do we coldly view an extremely premature infant as a learning opportunity, because that's what the extremely premature infants generally are? At what point does care become cruelty? At what point does a lifetime of debt that is now impossible to pay off or declare bankruptcy to avoid trump the right of a premature infant to a chance at living?

These are all tough questions and they're all going to have to be answered at some point if this country ever moves away from the extreme cruelty of rationing care by financial status toward rationing care by it's statistical likelihood of working to extend quality of life.

[mnmod]

6. I would guess

but rather to the fetal stage of development. Yes, we can save a few infants who are born weighing less than 32 ounces, but are the heroics worth it to anyone but the parents?

I would guess to the kid who was just born..

We know that underdevloped infants can be saved but will generally face a lot of problems in later life, although there are rare exceptions.

Actually 70% of those saved hve no, minimum (squint), or minor problems.

These are all tough questions and they're all going to have to be answered at some point if this country ever moves away from the extreme cruelty of rationing care by financial status toward rationing care by it's statistical likelihood of working to extend quality of life.

When the Canadian govt told my grandfather he was not worth the Chemo it pushed me out of step with the left on health care..

[Warpy]

17. Your stats include preemies over 32 oz.

How old was your grandfather? What was his general condition? There comes a time when chemo will ruin one's life a lot more effectively than cancer will. Would he prefer a shorter life with a higher quality? Or was he going for time, puking for months and crippled with arthritis and wracked with pain afterwards? Chemo is extremely hard on the healthiest young adults. It is devastating for most people over 70.

I'm afraid medical ethics decisions aren't as simple as families think they are. All treatments have significant risks, and some are simply not worthwhile, and some of those are based on age and/or condition. Sometimes the cure really is worse than the disease.

[mnmod]

21. He was

late sixties and other than bladder cancer in great health. If they had started the chemo right then and there he probably would have lived. The time it took him to get to the US and start chemo here was too much, the tumor nearly went away but then the treatment stopped working, a week let alone the month would have made all the difference..

[RBHam]

4. flame

bait

[mnmod]

8. No, just news worthy..

[Walt Starr]

5. I disagree with this stance completely

By continuing to attempt to save babies which are more and more premature, we will eventually be able to develop technology through which aborting a pregnancy will no longer mean destroying the fetus.

I'm in favor of medical advances. This is one area where advances can only have a positive effect.

[mnmod]

7. That would be a great ending to the abortion debet!

[Walt Starr]

9. Which is part of why I believe Republicans vehemently oppose any

research dealing with fetuses. Once we are able to safely remove a fetus without terminating it, the abortion debate goes away.

[Warpy]

23. What are you going to do with all those "saved" fetuses?

There aren't enough couples willing to adopt them. Are you going to reopen large orphanages for them? What kind of people come out of those orphanages, cared for by professionals who have to maintain a degree of emotional distance in order to survive?

How many premature infants are you going to torture with the best care money can buy to get there, knowing their lives of days, weeks, or even months are experiences of nothing but pain?

There again, the ethics questions are still sticky, although the Brave New World incubation tanks would seem to be a solution to shutting up the Religious Wrong.

What if a woman doesn't want the fetus saved in a tank? There are other issues at work here, namely the issue of never knowing what has happened to one's genetic offspring. Death is final, at least, and life can go on. Oh, and THINK of the incest down the road as people who don't know who their genetic parents are go on to marry.

Medical ethics get umbelievably sticky, and there are no good, simple answers to any of the questions.

[mnmod]

My father

There aren't enough couples willing to adopt them. Are you going to reopen large orphanages for them? What kind of people come out of those orphanages, cared for by professionals who have to maintain a degree of emotional distance in order to survive?

Thanks..

[Walt Starr]

25. As medical science advances, so does education of the masses

If people were actually educated about sexual reproduction, abortion would become extremely rare. The biggest problem is education.

And with education making abortions rare, there would not be a huge need for adoptive parents of fetuses.

[bleedingheart]

10. have you ever had a child in NICU?

I have.

BUT I was one of the lucky ones, my baby was born at 36 weeks and still needed assistance.

I saw babies die in the NICU a long linger death as the doctors were experimenting on those tiny little babes.

My daughter's NICU bill was $90,000 for just 10 days and I was lucky to have insurance and a relatively healthy almost term baby.

[Walt Starr]

12. I used to work in a hospital

And I'm sorry, but what doctors learn from those cases where they fail gets applied and they end up with cases where they succeed.

If this attitude had been taken when 7 month gestation premies were more apt to die than live, then there would never have been cases where 6 month gestation premature birth was anything other than a death sentence.

[bleedingheart]

15. well we better fix the healthcare system first because the last thing

these parents of brain damaged preemies need is more bills.

[mnmod]

18. 70% of those who survive pre 25 weeks

Have no severe mental handicap..

[bleedingheart]

19. show me the link to support that

i want to see the neonatology references that support that...

[mnmod]

24. From the Article

The EPICure study of babies born at 25 weeks or less, led by researchers at Nottingham University, found that, by the age of six, only 20% of surviving children had no disabilities; 22% had severe disabilities, including cerebral palsy; while 34% had milder problems such as a squint.

Right away we are talking about 54% of kids (20 with none, and 34% with mild) with no problems. Only 22% have severe disabilities, the other 24% have to fall in the middle of that meaning mild or minor problems.. Your post implied that most if not all these kids end up with severe mental problems... not the case..

[bleedingheart]

27. 80% have disabilities that vary

but it is a dice roll....and this is just one study.

[mnmod]

28. They are counting things like squint!

more than half have nothing more than things like squint (eyes look kinda funny), Im sure they are including minor asthma and the like. The big number to take out of that was only 20% have as you put it are "brain damaged preemies"...

[Walt Starr]

22. Oh I agree with that completely

Single payer universal healthcare is an aboslute must and will result in much swifter and more reliable adavances in medical science.

Of course, those advances will include aborting pregnancies not meaning terminating fetuses, which blows the Republican power base all to hell so of course they hate universal healthcare.

[mnmod]

16. If medicine does not push the limits then..

The limits will never change...

[Mizmoon]

13. As the mother of a premature baby

who is about to graduate from high school, I say, "Not so fast ..."

[theboss]

20. This assumes that technology will never advance

And hence, is a stupid position.

[Bunny]

26. My nephew's wife just had a baby.

She was born at 26 weeks gestation. She weighed 1 lb. 3 oz. at birth. I can see a lifetime of problems for this tiny little girl, assuming she gets a chance at a lifetime. Who is to say what the answer is? If either of my kids had been born at 26 weeks, I would have wanted the doctors to move heaven and earth to save them. At least initially, anyway.

[RedCloud]

29. Let all life live!

Well that's my goal. I guess i will eat some plants and maybe accidentally consume many microorganisms so maybe I should say, Let all human life live. That sounds so unfair to the rest of the planet.

Give them all a chance. And the benevolent aliens will help us with their technology to overthrow the Diebold empire.