The Ethics of Keeping Micropreemies Alive

  1. From Advance for Nurses, October 14,2002:

    When Saving a Life May Not Be In the Patient's Best Interest
    By Michael Donnellan, MBA, RRT
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    About NRSKarenRN, BSN, RN Moderator

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  3. by   sjoe
    This issue was put very clearly by one NICU doc: "We are almost at the point where we can keep a Big Mac alive. The questions we have to ask now are about 'why?'." (And at $3000+/day.)
    Last edit by sjoe on Dec 3, '02
  4. by   rosaria
    :kiss I wish that we would try to encourage those (teens that are pregnant, and substance abusing people that are pregnant to get nutritional help for themselves and for their unborns. I guess it's something we can do wherever we live. Let's all try to do one good deed in that direction...maybe a new year's thing to do. What you do might make the difference for one little life....:kiss
  5. by   emily_mom
    But, you can't lump these stats together and blame the parents for all preemie births. Sometimes it is just an act of God and we must accept that and move on. Parents feel enough guilt when a child is born premature. We can't make them feel as if there was something they did. It's true that we need to educate everyone, but people will always fall through the cracks. Some don't care, some face addiction, some have no support.

  6. by   rosaria
  7. by   canoehead
    If we took the money spent on premies under 500G and spent it on free prenatal care I betcha we would save more lives.
  8. by   shay
    Personally, I left my NICU job due to the medical director's insistance that we save 23 weekers. It was cruel and unusual punishment, IMO.

    I think it's torture and it's wrong.
  9. by   OBNurseShelley
    I totally agree shay, and giving parents the false hope their 23-24, 25 weeker will actually survive and survive successfully is an AWFUL thing to do. I know THAT NOONE ever wants to lose a child, but let's be REALISTIC here! When do we stop, when do we draw the line?
  10. by   Anaclaire
    The Level III NICU I worked in in Georgia two years ago had three neonatologists and 6 NNPs who were very good about visiting with the undelivered parents in L&D or on the Antepartum floor as soon as they were admitted to talk to them about the chances of survival for their baby (oriented to the gestational age of the baby still in the womb), realistic senarios of life in the NICU, and some paperwork to let them have to reveiw on their own after the initial meeting. The neos and NNPs would then visit the parents either a few hours later or the next day to see what questions were on their mind and to talk some more. If the Mom was able to come to the NICU in a wheelchair she was usually brought to our NICU to see for herself where her baby might be. The Daddy or significant other person in Mom's life would come too whether with the Mom or alone.

    We were all very please with our neos and NNPs taking initiative to not let any of these parents fall through the cracks. It made life much easier for the medical team and for the parents after the baby was born when decisions had to be made.

    There are of course the many NICU admissions who come straight off the street delivering as they hit the door and they were unable to receive the early intervention meetings with our neos and NNPs. More times than most people realize, a premature baby is born to parents who did everything right.

    I fully agree that ob-gyns need to talk more to their patients about premature babies. Parents need to at least be aware of the problems that can occur and the chances of survival as well as quality of life for the micropreemies. There is a classic tug-of-war between obgyns and neonatologists/pediatricians though... they don't seem to ever get along so great and I don't know why. Our hospital also had a perinatologist who attended to the high risk undelivered moms and was very good about contacting our NICU for support and was also good about keeping a realistic tone with the undelivered patients when speaking of their unborn micropreemie.

    But you know, when people are pregnant they never think they will be the ones to have a premature baby. They don't even want to think about it because is causes such anxiety. They are already preoccupied with the pregnancy and their busy changing lives as it is. And also, most folks hope for the best and want us to do everything possible to save their baby even when they are aware of the statistics. Of course they think their baby will be one of the miracles they hear about. I suppose it's our subconscious way of keeping ourselves from going insane in a crisis.

    I have no answers. I agree the media needs to show both sides of the coin... the shiny pretty side and the horribly ugly side. Prenatal classes and obgyn offices and other agencies caring for pregnant parents should offer more information about micropreemies, even if it's just in a simple brochure. Anything to get them to thinking about what they'd do "if" would be a step in the right direction.

    I'll hush now.