Comments on: Should letting a premature infant die be considered health care rationing?

By: Anonymous

Anonymous — Tue, 16 Aug 2011 16:34:00 +0000

I feel for this mother. However it is not a choice she is capable of making. The great thing about trying to do something, anything is that you can’t have regrets cause you did all that you could. For her it is understandable the what if’s. My husband and I were faced with a preterm situation at 22 weeks. The doctors told us there would be nothing they could do. The thought of having to watch my baby die was something that I could not comprehend. But the other side of it, the side the doctors and nurses know all to well is that if they had tried it would have made him suffer. And as a parent thats the last thing you should want. When the odd’s for your babies survival practically don’t exist you have to make the only parenting choice you’ll be allowed, I’ll live with the pain then watch my baby suffer for any amount of time before he dies. I do feel however that this situation will only get better. They have made so many strides in how early they can save a baby that I’m sure the timeframe that they are willing to try to intervine will continue to grow.

By: Stacy

Stacy — Thu, 01 Oct 2009 18:27:46 +0000

Thanks for posting this! As a parent of a 25.5 week preemie, I have a strong passion for discussing the long term impacts of prematurity-that is rarely discussed in mainstream media.

Thanks to RR for putting the reality into words!

By: Alex

Alex — Tue, 29 Sep 2009 13:42:09 +0000

I am a UK obstetrician. Can I just point out to the previous poster that this would not be counted as a stillbirth in the UK. Deliveries of fetuses who show no signs of life before 24 weeks gestation are miscarriages, those after 24 weeks stillbirths. If an infant shows any signs of life (as occurred in the case under discussion) after birth then it is counted as a live birth with subsequent death and the appropriate certificates are issued, whatever the gestation.

By: ninguem

ninguem — Mon, 28 Sep 2009 18:47:24 +0000

“……The decision should be made by those who are responsible for payment. Unless the parents want to pay for medical treatment for their premature infant, then the insurance company should have the final say…….”

Well, agreed. But then, don’t take away my money in taxes for a healthcare system I don’t want, let me make decisions for my own healthcare.

That baby, born before a certain gestational age, is called an abortus in the UK and on the Continent. In the USA, it’s a live birth. And yes, it most likely will die……though I’ve also seen babies that size that lived and did well.

But here’s it’s called a live birth, and when it dies, it’s counted as an infant mortality. Across the pond, it’s called a stillbirth. Bear that in mind when comparing infant mortality statistics.

By: H

Mon, 28 Sep 2009 02:39:29 +0000

The decision should be made by those who are responsible for payment. Unless the parents want to pay for medical treatment for their premature infant, then the insurance company should have the final say. Perhaps it should be written into policies whether premature infant care is provided and appropriate rate increases should occur for those who want that benefit.

By: Dr. Mary Johnson

Dr. Mary Johnson — Mon, 28 Sep 2009 02:17:53 +0000

An important caveat: 24 weeks AND/OR 500 grams (assuming dates are accurate). A physician can always exercise his or her own discretion, based on what the baby looks like and what it does at birth.

Indeed HH, many tertiarty OB centers will not accept a referral for laboring/ruptured Moms less than 24 weeks gestation (the referral being made on the premise that an uber-premie has a better chance for survival delivering in a hospital with a NICU). The outlying/referral hospital holds on to the Mom and copes with whatever happens until 24 weeks.

Pins and needles.

By: The Happy Hospitalist

The Happy Hospitalist — Mon, 28 Sep 2009 01:57:57 +0000

Premies before 24 weeks are treated as non viable just about every where I this country. Not offering resucitation is the accepted scientific standard.

By: Dr. Mary Johnson

Dr. Mary Johnson — Mon, 28 Sep 2009 00:58:26 +0000

KipEsquire, insolence is my specialty. And I respectfully beg to differ with you.

In all good conscience, there was no “treatment” to be offered to this baby.

The doctor in this case decided that the guidelines in place were medically appropriate and declined to intervene. And that decision was all of the things you list . . . logical, cost-effective, humane and compassionate.

One more thing. Speaking as someone who once was fired for defying threats in order to save a critically-ill newborn’s (not a premie) life, you really need to sling the “cowardice” tag elsewhere.

I’m not your girl.

By: DMS Student

DMS Student — Sun, 27 Sep 2009 23:36:47 +0000

So what if “a decision was made”? There are things that physicians cannot, in good conscience, do, even at the request of their patients. A physician can’t just write a script for Oxycodone because a patient wants it. A physician shouldn’t (potentially) torture a miscarried child (like this one) and waste resources for no foreseeable gain just to placate the parents. I understand the parents were distraught, but biology and our current level of technology make it so that this child couldn’t be saved. I have no problem with trying to save preemies that have a chance. This preemie, however, never had a chance.

“KipEsquire”: I assume that you are an attorney. Just as there are things attorneys won’t do for clients (violate ethical principles or the law), there are things that physicians won’t/shouldn’t do at the request or their patients or the guardians of those patients.

By: KipEsquire

KipEsquire — Sun, 27 Sep 2009 21:18:44 +0000

Anon #3 is exactly right.

A decision was made. A treatment was denied. A life ended.

Maybe the decision was 100% logical, cost effective, and even humane. But it was still a decision. A decision made by someone who was neither the patient nor the patient’s loved ones.

To suggest otherwise is sheer insolence. To cloak it in blather about “compassion” is intellectual cowardice.