when to save a premature baby - page 7
From: The Sunday Times - Britain June 05, 2005 Expert tells doctors:... Read More
Jun 24, '05Joined: Jul '00; Posts: 11,351; Likes: 388Thanks Steph, but I should tell you that I have found ethics committees to be completely useless in the real world. All they can do is give an opinion. If it isn't somewhat binding, there are going to be cases where the courts will have to get involved. We sometimes go to court to force treatment (like blood transfusions) and I think we sometimes should go to court to stop it. Doctors are so afraid of lawsuits that they will often torture (aka treat) babies who have no chance for survival.
Jun 24, '05Joined: Dec '02; Posts: 41,761; Likes: 48,081Quote from fergus51Ah, well see what happens when you read books instead of live life?Thanks Steph, but I should tell you that I have found ethics committees to be completely useless in the real world. All they can do is give an opinion. If it isn't somewhat binding, there are going to be cases where the courts will have to get involved. We sometimes go to court to force treatment (like blood transfusions) and I think we sometimes should go to court to stop it. Doctors are so afraid of lawsuits that they will often torture (aka treat) babies who have no chance for survival.
Jun 25, '05Joined: Sep '03; Posts: 2,378; Likes: 2,865We actually have a long drawn out policy about care of the extremely premature for our hospital. It states basically that
<23 weeks: absolutely only comfort care offered
23 0/7 to 24 6/7: left up to the parents if they want resus or not but will be offered.
25 wks up: there will be resus and I think the parents would have to go to court to refuse life-sustaining treatment in the absence of severe problems (bleeds, trisomy 13/18).
Of course with all infants regardless of gestational age treatment can be withdrawn with agreement of all parties (overwhelming NEC too unstable for surgery, maxed out on drips and vent/osc).
The big if on all those gestational age is the kids don't come out with labels on their heads, sometimes dates are off and it's a collaborative effort between the ob/gyn and neonatologist to assess the infant's gestational age at birth. We don't have absolute weight criterion. We've given comfort care to 600 gram 22 weekers and resus'd <300 gramers that were IUGR (none have lived yet).
I think all would have a different perspective about this if they had to care for a few former 23 weekers. Not one that was your child because ya'll know that it would be too difficult to be objective. I don't have the answers but I wish we could ask those little souls what they were willing to endure. I know, not realistic.
As for government getting invovled. . . when has that ever helped things? This from someone who doubts the ethics of resus'ing <25 weekers but I still don't think the government ought to be in the middle of it. Please, those out there with those miracle babies; please don't flame me. I would pray to never have that experience, I just see a lot of suffering and wonder if I'm really "doing no harm".
Jun 27, '05Occupation: NICU RN Joined: Oct '00; Posts: 2,537; Likes: 369lil Peanut and BBG bring up very valid points. For every one, "My baby was a 23 weeker and his doing great" story there are dozens of others out there trached, blind,deaf, feeding w/G tubes, mentally disabled, have CP, pulmonary disease, ect....Although every possible risk is explained to parents as soon is mom is admitted to the hospital, parents act surprised because, "so and so's baby was 1 pound and now plays basketball" No one brings up so and so's blind child in the wheelchair.
Not that I'm saying that a blind child in a wheelchair is not worth living, but that's about 45% of the kids <25 weeks <500 gm I see that do go home. 50% never make it out of the NICU.
When I walk in and see a 450 gm bag of bones on HFV loaded up with Dopa, Dobute, Epinef, MSo4, I want to cry.