22 weeks: Do Not Resusitate
The Nuffield Council on Bioethics has recommended that premature babies born before 22 weeks or given intensive care. This news has angered some commentators, even though the Nuffield Council's proposal is merely a re-statement of current practice. Specialists tell us that no baby can survive at 21 weeks, while only 1 per cent of children born at 22 weeks survive to leave hospital -- and, even then, they may face significant developmental difficulties.
I think the BMA is right to regard "blanket rules" as mostly unhelpful in sensitive cases such as these, and doctors will continue to pay close attention to the attitude of parents faced with a very early birth. Health care economists point out that prolonged interventions in very early births may be a questionable use of limited health care resources -- and, though it seems unpalatable, health costs are certainly part of the equation. I'm also conscious that it's important to develop new procedures, technologies and techniques to assist premature births, and that further advances will clearly require continued interventions.
Some campaigners say every child has a "right" to specialist intervention. But there comes a point in all medical care when doctors and parents may need to accept that further interventions will merely prolong a child's distress without much hope of improvement. The Nuffield Council's merits serious consideration.
Comments
I think the reaction to this is illustrative of how contentious these related issues are. But perhaps the real problem is trying to come up with 'blanket rules', or universal practice, in the first place. William mentions healthcare costs. Only when healthcare costs are universal (ie. paid for by taxation) is this an issue. When healthcare is private - as it should be - it will be up to the parents alone how to proceed, and it will be up to them alone how much they are willing to spend on medical intervention at that stage.
I hate to be persistent, but it's clear that a libertarian approach to these matters is, as usual, the most sensible approach.
Yeah...what John said...
SG
John, of course if health care costs are entirely met by prvate contributions or insurance, then the health cost argument fails (obviously that's not the case in the NHS and I, for one, want to strengthen the NHS).
But the other argument remains: it's cruel to persist with treatment that causes further distress to a child without any real chance of recovery.
I certainly wouldnt like to be in the shoes of the calling the shots to a distraught couple, but may I pose a few questions which may be relevant;-
1) Perhaps the health economists could serve everyone better if they focussed on the extensive layers of NHS management that soak up all the extra money poured in to cut waiting lists. Otherwise it could appear they are missing the real drain on NHS funds and hitting the most vulnerable people in society instead, ie newborns.
2) Population control is seen by many as a very serious problem to be dealt with by many, from the UN down; But some would argue on very dubious grounds and with no open debate. I would be concerned if the mood music for these type of decisions globally was being set, even subconsiously, by people who had accepted this as a worthy objective.
3) I am not so sure I would throw such parents entirely back on their own resources, I dont see that we are being forced to be so hard on them. What if you were that parent JW?
At the same time, it would hardly be fair on anyone to milk NHS resources for remote hope.
4) Lastly, I recall an NI couple who took their child to Germany for cancer treatment when the NHS said all hope was gone, but the treatment worked. I would hope no cynical cash saving hands would be guiding such policy formulations.
5) Is it that we can't afford to treat children under 22 weeks - or just that we dont want to?
6) Has the value we set on a human life declined?
PB
William Keown, ceo of a Co Down trust for the disabled, has slammed these moves as contrary to the hippocratic oath.
A lifelong sufferer of cerebal palsy, he campaigns for dignity for the disabled.
I guess you can see his point in asmuch as these type of moves could be very offensive to disabled people, perhaps?
I have heard several other disabled people complaining, are we too quick to presume we understand what they would want?
www.wkeowntrust.co.uk
PB
Absolutely Anne. But in a society without the infernal NHS we wouldn't have to decide that for everyone, would we? Or are you really trying to say that the parents should NOT be allowed to decide whether or not to try and resusitate their own baby?
The Doctor should do what he is employed to do whatever sector he may be in, private or state employment, he is not employed to be God, it is his service to support the life the good and the welling being of his patient, supporting life to the best of his ability providing the same care and support that he would wish his own family to have, it is against his teaching and training to cause death actively or passively no matter what ethical slant one may put on it, the doctor supervised death (euthanasia or abortion) of a patient can never be morally justified.
Greetings! Have a nice day!
Greetings! Have a nice day!
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