My water broke at 20 weeks. We managed to make it to 28 weeks and she was born at 1lb 10 ounces. We were given these same dismal statistics. 1 percent chance of living. If she lived, possible cognitive delays, disabilities, ongoing medical issues, etc. She is a thriving 2 year old that lives a pretty normal life in spite of a handful of medical followups. We see a pulmonologist, cardiologist, gi, opthalmologist, endocrinology, pt, ot and speech. It has been an extremely difficult experience emotionally, physically and financially. But as a family we've done it and continue to do it every day. We have had to go down to one income and atill manage to pay our own bills. Our child has not created a drain on society where they now have to take care of all 3 of us. I am grateful that we were allowed to choose care for her and it was not dependent on cost and what her developmental level will be as an adult.
8
I was born at around 26 weeks gestation, weighing 1 lb 11 ounces. In 1980, it was considered a miracle that I survived and thrived. I'm very, very lucky, and I know that it is because of the wonderful medical care I received in the NICU. I'm sure it was expensive, but I'm grateful I was given the care I needed. I might have been a "miracle baby" but the doctors and nurses were miracle workers.
I just wanted to say that even though I'm a preemie who made it, against the odds at the time, I believe in a woman's right to choose to have an abortion if she decides she needs to (for all the reasons commentators have already said). I'm sad to see that preemie viability is part of the abortion debate.
I just wanted to say that even though I'm a preemie who made it, against the odds at the time, I believe in a woman's right to choose to have an abortion if she decides she needs to (for all the reasons commentators have already said). I'm sad to see that preemie viability is part of the abortion debate.
2
NYT comments at their best. I have read down the Reader's Picks and taken together they are a Health OpEd in themselves and far more useful than the article.
I encourage the author and at least one Times Editor to read these reader picks and re-think the approach to Health articles that the comments make clear is needed.
I encourage the author and at least one Times Editor to read these reader picks and re-think the approach to Health articles that the comments make clear is needed.
5
One really has to wonder about the moral foundations of "medical professionals" who basically serve the corporate interests of the hospitals in which they work.
Comments here from physicians and nurses familiar with the NICU are almost universally against the prolongation of suffering of these not-really-but-we'll-make'em viable babies. Yet as commenters also note, the NICU is a cash cow for hospitals.
The pure evil of that statement is just breathtaking.
Comments here from physicians and nurses familiar with the NICU are almost universally against the prolongation of suffering of these not-really-but-we'll-make'em viable babies. Yet as commenters also note, the NICU is a cash cow for hospitals.
The pure evil of that statement is just breathtaking.
7
Yet another reason why expectant parents must choose their prenatal care and hospital wisely. Treating at 22 or 23 weeks gestation should be up to the parents, not the hospital. It's an agonizing decision, but it must be done in these cases.
5
It is sweet but misleading to show photos only of the success stories. Babies born extremely immature are not always be provided with the loving and positive families portrayed here.
Since bringing a child into the world and raising them is the most important job most adults will ever perform, perhaps the state legislatures so intent on ‘educating’ potential young mothers, frequently unwed or single, some of the challenges they and their child will face? How about having them view a little short that interviews families who face working with children who have psychological problems, genetic disorders, learning disabilities, autism, Downs Syndrome, Spinal biphida, rubella related brain damage, fetal alcohol damage, or personal accounts of mothers suffering from severe postnatal depression psychosis? Shouldn’t they be informed that During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety? How about a few interviews of children left for foster homes, or talking honestly about the challenges of adoption? I know of several parents who would like to talk about the cost of educating a child starting with pre-school tuitions that force three or four jobs onto mom or dad. Why not take all those stuffed animals, lollipops and bunnies down from the Ob-gyn wall and show what life is really about?
Since bringing a child into the world and raising them is the most important job most adults will ever perform, perhaps the state legislatures so intent on ‘educating’ potential young mothers, frequently unwed or single, some of the challenges they and their child will face? How about having them view a little short that interviews families who face working with children who have psychological problems, genetic disorders, learning disabilities, autism, Downs Syndrome, Spinal biphida, rubella related brain damage, fetal alcohol damage, or personal accounts of mothers suffering from severe postnatal depression psychosis? Shouldn’t they be informed that During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety? How about a few interviews of children left for foster homes, or talking honestly about the challenges of adoption? I know of several parents who would like to talk about the cost of educating a child starting with pre-school tuitions that force three or four jobs onto mom or dad. Why not take all those stuffed animals, lollipops and bunnies down from the Ob-gyn wall and show what life is really about?
6
My twins were born at 28.5 weeks and are happy healthy spunky 4 year old now. They converted me from pro-choice to pro-life the moment I heard their heartbeats in the ultrasound at around 18 weeks gestation. The two months I spent with my boys in the wonderful NICU, seeing so many babies born even younger than mine, fighting, surviving, and so many of them making it, completely turned by view of human life upside down. It was gritty, inspirational, and life-changing experience. Anyone who is pro-choice after 20 weeks, please go visit, or better yet, volunteer in a NICU. I fully understand the painful moral choices parents must face whether or not to pursue treatments for 22 or even 23 weekers. Few parents may even realize the rough ride their life is in for. But for heaven's sake, I will never understand parents who willingly terminate perfectly healthy pregnancies.
5
The documentary Little Man may provide a helpful perspective.
2
It looks like 23 weeks of pregnancy is required even for moderate chances of the baby becoming healthy and normal. 22 weeks looks to be too early, if the stats given here are accurate, and I understand them properly. These terms are a full 4 months and a week, or two, short of a full term pregnancy. They are almost half as long as a regular pregnancy.
What all this says about the pro-life versus pro-choice argument, I don't know. One question comes to mind: how could a fetus that can't survive on its own be considered to have the same legal rights as a full-grown adult?
As others have mentioned, it is the astronomical costs of saving 22 week old and under babies, which are really still undeveloped fetuses, that needs to be taken into consideration, even though it ultimately won't be because, for those with money, it is no object to treating their loved ones. It is interesting that it is the beginning of life (fetuses, babies and infants) and the end of life (people of old age) which cost our medical system, and by extension, our citizens, so much extra money, and yet this will never be part of any political or social argument re healthcare in the U.S. What this means is it is impossible to cap our healthcare costs. This will not happen.
6
"One question comes to mind: how could a fetus that can't survive on its own be considered to have the same legal rights as a full-grown adult?"
Or: How can a fetus be considered "viable" if it can't breathe or eat without a life support system that mimics the womb?
Or: How can a fetus be considered "viable" if it can't breathe or eat without a life support system that mimics the womb?
6
Claudia, without implying in any way this is a simple decision, I will point out that there is no baby which can survive on its own.
6
My daughter was born 10 weeks early in order to save my life. Her weight was 2 1/2 pounds and she fit in my husband's hand. After 10 weeks in the NICU at San Diego Naval Hospital she was able to come home at 5 lbs. She had digestion issues and sever reflex. Also she was allergic to my milk. She is now a beautiful 19 year old woman who is very active and plays college softball. We found out in elemantry school that she does have a learning disability of auditory processing. I know not all situations turn out like mine and believe me I know that we are extremely blessed. She is always our miracle baby.
7
Many of the comments on this article are really troubling to me. A baby is not simply a "cost" but a real human being who is already on his or her way into the world. I doubt if it were your own child, you'd all be so cavalier about suggesting that we have plenty of babies in the world and breast cancer patients don't get all this attention and so on. The world is a bit more complex than that. First, adopting all those "spare" babies is not as simple as the commenters make it out to be. Second, the money going to these babies is not simply taken away from poor and needy children. That's a disingenuous argument. There's actually plenty of money going around in plenty of places that should be going to poor and needy children. It doesn't and never has come down to fragile preemies versus poor and needy children. I'm not sure why so many commenters are committed to making some sort of larger point about not spending money on these infants. When I was pregnant last year, if I had gone into labor at 23 weeks, you better believe I would have done everything to save my child. I wouldn't be sitting there having philosophical discussions about whether that much money should be spent and whether my child deserved a chance at life any more than anyone else. Of course she did, to me, as her mother. I challenge any of the commenters to argue believably that they would do any different if they were the unfortunate parent of an extreme preemie.
13
Well said. I couldn't have said it better.
3
The arguments from the individual perspective do not and should not squelch the arguments from the group, or societal, perspective. America is a wealthy country, but that wealth is not, in any way, evenly distributed. For most of us, the money runs out long before any sketchy medical options do. It is fine for well-to-do parents to want the best for their prematurely born children, but what happens to the rest of the prematurely born children born to those struggling to make ends meet? We all pay for these children to be born and survive, that's what happens. It may not appear to be so directly, but the the costs of extremely expensive medical procedures are ultimately born by us all. This is the argument America refuses to have because the argument is controlled by the extremely wealthy, I.E. those in power, the ones who pay the politicians to do their bidding.
4
Once a newborn is deemed viable, no matter the odds of its survival or health, parents have little or no say in whether extreme measures are taken. Major medical centers seem to be in a contest to see who can "lower the bar," regardless of long-term consequences.
5
i was a premature baby, born in 1952-i was 1 lb 13 oz. no high-tech back then.i will be 63 in about 11 days from now. i have nothing but praise for the doctor who helped me into this world.i know a higher power played a part. in my case i feel being born too soon a blessing and a curse. blessing-breathing, seeing the beautiful planet earth-parents-siblings-etc-curse-mild cerebral palsy-could have been worse-but any cerebral palsy i wish for no one. hearing problems,eye problems,curvature of spine-back problems-yet in spite of times i wish i didnt survive the truth is look at all i would have missed. i was lucky- i hope more babies born at 6 months and earlier will live and with few or no health effects. i forgot to mention i was born at 6 months-3 months early
6
It is interesting that the NYT wrote this article in the best possible light. "In the 78 cases where active treatment was given [22 weeks], 18 survived, and by the time they were young toddlers, seven of those did not have moderate or severe impairments."
Another way to say this is "most 22 week premies are not given extreme and costly treatment. Of the 78 treated, 60 died (77%), and by the time they were young toddlers, 11 (61%) had moderate or severe impairments."
Another way to say this is "most 22 week premies are not given extreme and costly treatment. Of the 78 treated, 60 died (77%), and by the time they were young toddlers, 11 (61%) had moderate or severe impairments."
22
Neonatal intensive care units are reimbursed $3000 - $5000 dollars PER DAY for the infants in their care. NICU reimbursement is one of the few profitable revenue streams for hospitals - cash for the hospital, not for the doctors. I would like to believe altruism is the reason for attempting to save extremely premature infants however, hospital administrators (the majority of which are non-physicians) may encourage a policy of heroic (but futile) intervention for financial reasons and in the process gain a reputation for "doing everything possible" which is very comforting to a parent facing delivery of a very premature infant.
4
One thing I fear is that the choice of pursuing advanced medical treatment for the premature baby or to let it die will be taken away from the parents and given to the doctors and the hospital. The consequences of what ever decision is made under such circumstances will be born by the parents. I think the decision of what course to take should be theirs too.
7
"The consequences of what ever decision is made under such circumstances will be born by the parents"
But that's the problem: The consequences aren't all borne by the parents. Unless they are a member of the 1% they couldn't possibly bear the expense of saving, incubating, and caring for a severely compromised child.
But that's the problem: The consequences aren't all borne by the parents. Unless they are a member of the 1% they couldn't possibly bear the expense of saving, incubating, and caring for a severely compromised child.
4
Those making the decisions concerning these very premature babies should be informed very clearly about the high likelihood of a deformed child if the baby survives. They should also know how very difficult it is to raise deformed children and the great strain that it places on most families.
8
I read an article in which a NICU nurse commented that she sometimes wanted to tell the frantic parents of some desperately ill newborns that the best thing they could do would be to give up and try again. Most likely, next time, they would get closer to full term and go home with a well baby and a much lower risk of personal, medical and financial fall out. I am the mother of a premature infant and I remember my husband and I telling ourselves that we would be tough and tenacious and loyal no matter what we were confronted with, but we ended up with a very healthy child in spite of the shock of an early birth. In thinking about this circumstance and the difficult decisions parents are being asked to make, it's important to remember that no matter what decision they do make, no parent would ever have wished this misfortune on anyone, let alone their own child, and that facing the odds is not the same thing as abandoning your child.
9
I was just like the babies born in this story. I was born at 22 weeks, weighing 1.1 lbs, 24 years ago. I have learned my lesson about never reading the comments. It's was heartbreaking that so many people are putting this (my life!) down to an economic transaction and saying that my doctors should have never intervened. I am very lucky to have survived and thrived with no health problems beyond glasses and mild asthma. I'm a university graduate and running a 5k in a couple weeks. I've been healthy, happy and active my whole life. Please just try and remember that these parents and children you are dismissing so casually may be reading this article too.
10
It's not my intent to interrogate or distress the many commenters here who are raising children born extremely prematurely, and reporting their children or grandchildren "have no major issues" or "are doing beautifully" or are precious and loved.
These commenters do report that the children spent months in the NICU.
It's fair, in a discussion like this, to ask more detailed questions. Are the children receiving medical, rehabilitative and special educational interventions now? How many professionals are involved in their ongoing care? What sort of cognitive delays or problems do they experience, and what is the care plan for treating or ameliorating them? What is the cost to date and the projected ongoing costs for an average lifetime?
Without these answers, how can society understand the complete picture of what saving an extremely premature infant means?
Not every family will have grandparents, in-laws etc. who can pitch in and help not only with the care of the preemie, but of other children in the family, or offer financial assistance, or run errands, etc. Commenters living in big cities like Boston or New York are never far from excellent medical facilities. What about families who must take a fragile child home to a community far from such facilities? How will they travel back and forth?
Are readers ready to pay a family's mortgage because the parents have lost their jobs or must take unpaid leave to care for their child?
These commenters do report that the children spent months in the NICU.
It's fair, in a discussion like this, to ask more detailed questions. Are the children receiving medical, rehabilitative and special educational interventions now? How many professionals are involved in their ongoing care? What sort of cognitive delays or problems do they experience, and what is the care plan for treating or ameliorating them? What is the cost to date and the projected ongoing costs for an average lifetime?
Without these answers, how can society understand the complete picture of what saving an extremely premature infant means?
Not every family will have grandparents, in-laws etc. who can pitch in and help not only with the care of the preemie, but of other children in the family, or offer financial assistance, or run errands, etc. Commenters living in big cities like Boston or New York are never far from excellent medical facilities. What about families who must take a fragile child home to a community far from such facilities? How will they travel back and forth?
Are readers ready to pay a family's mortgage because the parents have lost their jobs or must take unpaid leave to care for their child?
11
Thank you for bringing up these important issues that face families.
5
The discussion should revolve around wanted children not those who are not desired for whatever the reason may be. Raising a child is hard enough. If the parents don't want the child it's even worse for all concerned. Why must every discussion about extending the viability of a fetus come around to abortion? To the woman who does not want it this is another way to interfere with her bodily rights. A fetus that cannot survive without intensive care outside the uterus is not an independent life. If the fetus is a baby and wanted the discussion is logical and desirable. If not all that is happening is foisting an unwanted burden on the woman or the family.
We need to focus on making sure that all children who are born are wanted. We should focus on providing prenatal care for all pregnant women whether it's abortion or prenatal care. We should focus on providing for the infant after birth. We should also provide reliable birth control to all who want it. And yes, we should provide the best care possible to a premature baby as long as it's reasonable to do so.
We need to focus on making sure that all children who are born are wanted. We should focus on providing prenatal care for all pregnant women whether it's abortion or prenatal care. We should focus on providing for the infant after birth. We should also provide reliable birth control to all who want it. And yes, we should provide the best care possible to a premature baby as long as it's reasonable to do so.
8
I'm not sure I follow your point. This article is about wanted children. If a baby born at 22 weeks wasn't wanted the pregnancy would have been aborted long before the premature delivery.
If you ask a mother who has had to make the heart-wrenching decision to either terminate a much wanted pregnancy because of poor prognosis, or to take her baby off of life-support, the odds are low that she provide for you a cost benefit analysis of her baby's stay at the NICU. She will, however, tell you quite a lot about her need to spare her baby the physical pain and suffering its tiny body would most surely endure. These are heartbreaking "choices" that no one should ever have to make, however, sadly, many women must.
13
Just like in the abortion debate, where the rest of us (the majority) can see grey areas and don't believe in black and white pronouncements and can see why there should be exceptions to every rule, the premature babies debate will be dragged down by the tyrannical views of a closed-minded minority, who, along with lowering the age of fetus viability lower and lower and proscribing the right to an abortion, will also demand that we aggressively treat and save each and every preemie, even if it has a 50% chance of a miserable existence.
When are we going to tell these bullies, "Enough!"
When are we going to tell these bullies, "Enough!"
16
Everybody is talking about children. But what about the adults these children will grow into? America is a terrible place for adults with intellectual or physical disabilities. There is no communal infrastructure, no protected housing for autistic or intellectually disabled adults, such as exists in Scandinavia or Israel. You doom a family to caring for a severely disabled son or daughter their entire lives but what happens when the lives of the parents end? This cute baby you insist on saving against all odds will be the muttering, twitching homeless person you will cross the street to escape.
15
Or their siblings -- either existing or later conceived to provide for the disabled child after the parents are dead -- are indentured to a lifetime of responsibility without any say in the matter.
5
This is an interesting article, but I wish that it would have included a few stories of parents who lost their micro preemies, or parents whose children are severely disabled, which according to the data are the vast majority. These rosy anecdotes are important, but let's be realistic, they are the minority of stories.
22
I guess this is why we get nowhere in this country when profound and complex moral issues must be discussed and addressed.
It's pretty disgraceful to heap vitriol on parents who are desperate to save a child.
It's pretty unrealistic to accuse people who bring up the reality of costs in our non-magical world of being venal monsters.
This is most particularly an issue where loving compassion must be joined to practical realities.
We have all seen and read the fictional and nonfictional stories of parents who for whatever reason wanted to withhold treatment from a child, and were not only vilified but dragged through the legal system. Although those cases involve treatable medical conditions for older children, I can well imagine that parents struggling, at the worst moment of their lives, to make the best choices for a loved and wanted child (in most cases) may have their decision complicated by the fear of being vilified as bad parents who gave up on their child.
We're not very good in this country at assembling supportive teams comprised of medical professionals, an ethicist, a religious adviser if the parents so desire, and educational experts, so that frantic parents could have a genuine conversation laying out the consequences of each possible choice.
Sometimes a parent just wants and needs to be comforted herself; told that declining treatment is ethical and loving; that not even the most qualified "expert" can give guarantees or accurate projections.
It's pretty disgraceful to heap vitriol on parents who are desperate to save a child.
It's pretty unrealistic to accuse people who bring up the reality of costs in our non-magical world of being venal monsters.
This is most particularly an issue where loving compassion must be joined to practical realities.
We have all seen and read the fictional and nonfictional stories of parents who for whatever reason wanted to withhold treatment from a child, and were not only vilified but dragged through the legal system. Although those cases involve treatable medical conditions for older children, I can well imagine that parents struggling, at the worst moment of their lives, to make the best choices for a loved and wanted child (in most cases) may have their decision complicated by the fear of being vilified as bad parents who gave up on their child.
We're not very good in this country at assembling supportive teams comprised of medical professionals, an ethicist, a religious adviser if the parents so desire, and educational experts, so that frantic parents could have a genuine conversation laying out the consequences of each possible choice.
Sometimes a parent just wants and needs to be comforted herself; told that declining treatment is ethical and loving; that not even the most qualified "expert" can give guarantees or accurate projections.
34
"I can well imagine that parents struggling, at the worst moment of their lives, to make the best choices for a loved and wanted child (in most cases) may have their decision complicated by the fear of being vilified as bad parents who gave up on their child."
Thank you for saying this—I suspect it lies at the heart of many sad stories. And it seems likely the same applies to children who fear that if they don't agree to a bone marrow transplant for a 95-year-old man, people will say they didn't love Grandpa enough.
Thank you for saying this—I suspect it lies at the heart of many sad stories. And it seems likely the same applies to children who fear that if they don't agree to a bone marrow transplant for a 95-year-old man, people will say they didn't love Grandpa enough.
4
There is no reason that anyone should be vilified for making a decision that is theirs alone to make. There is no reason that anyone needs to know anything other than the fetus wasn't viable.
1
I am an Ob/Gyn doctor. This article and the picture of the pretty little girl are VERY misleading. The odds of neonatal survival at 22 weeks of gestation are dismal. Great majority of these extremely preterm babies will die, and if a baby survives, parents will likely deal with a lifetime of abnormalities, morbidities and handicaps.
32
Our granddaughter was born at 24 weeks in 2004...due date Feb 15, born Oct. 28, at just over 1lb and twelve inches long, she was in Cornell for just over 4 months. Now Gabriella is10 years old and doing beautifully. There are no major issues and she is our miracle grandchild and her parent's miracle daughter, a wonderful sister to her nine year old sister and almost five year old brother. We are forever grateful to an exceptional team of nurses and doctors.
5
It is not that some babies are "unworthy of saving," as some commenters accuse other commenters of feeling or stating.
It is that we are forcing those babies to suffer the consequences of medical advancements unaccompanied by true and meaningful compassion and realistic prognoses.
As the very blessed mother of a healthy full-term child, I was astonished at the level of awareness and responsiveness of a newborn from the moment of birth--and I'd say from within the womb too, the nearer to term my child was.
The terror and pain experienced by these babies in the NICU must be truly beyond bearing. Undoubtedly the horror of some interventions must trigger responses in the babies requiring other interventions.
As quite a few commenters have observed, the most humane--and medically wise--protocol might be to have the parents cuddle and soothe such tiny preemies for the first 24 hours; those babies surviving that crucial time are likely the ones for whom medical intervention will be successful not just in preserving life, but enabling a decent life. A truly moral society would support and encourage parents in choosing that option without guilt or second-guessing.
It is that we are forcing those babies to suffer the consequences of medical advancements unaccompanied by true and meaningful compassion and realistic prognoses.
As the very blessed mother of a healthy full-term child, I was astonished at the level of awareness and responsiveness of a newborn from the moment of birth--and I'd say from within the womb too, the nearer to term my child was.
The terror and pain experienced by these babies in the NICU must be truly beyond bearing. Undoubtedly the horror of some interventions must trigger responses in the babies requiring other interventions.
As quite a few commenters have observed, the most humane--and medically wise--protocol might be to have the parents cuddle and soothe such tiny preemies for the first 24 hours; those babies surviving that crucial time are likely the ones for whom medical intervention will be successful not just in preserving life, but enabling a decent life. A truly moral society would support and encourage parents in choosing that option without guilt or second-guessing.
14
Finally doctors are discussing this! My son was delivered at 22 weeks and 6 days, and only offered life saving measures due to an error. One day matters in MANY hospitals!!
He survived and is an amazing 4 year old now, full of energy and tons of smiles.
Each life matters!
www22w6d.com
He survived and is an amazing 4 year old now, full of energy and tons of smiles.
Each life matters!
www22w6d.com
6
When you hug, kiss, sing to and lovingly stroke even a profoundly handicapped child, it will smile and react. It will take pleasure in that moment. Its parents will respond with reciprocal pleasure.
That does not mean the child's life is not a torment, most of the time.
These are terrible realities for families. Once the child has survived and goes home, parents often find exceptional courage, strength and resilience in caring for it. But the real strength and courage might have been in letting the child go, before it must endure years of suffering after the horror of the NICU experience.
There is no one answer for this dreadful dilemma. We can never truly comprehend the quality of life of another. We can only guess. But as many other commenters have noted, the neonatologists need to consider not just their scientific prowess, but their moral obligation to the entire family and its ultimate wellbeing. They must learn to say "we can do this, but we should not."
That does not mean the child's life is not a torment, most of the time.
These are terrible realities for families. Once the child has survived and goes home, parents often find exceptional courage, strength and resilience in caring for it. But the real strength and courage might have been in letting the child go, before it must endure years of suffering after the horror of the NICU experience.
There is no one answer for this dreadful dilemma. We can never truly comprehend the quality of life of another. We can only guess. But as many other commenters have noted, the neonatologists need to consider not just their scientific prowess, but their moral obligation to the entire family and its ultimate wellbeing. They must learn to say "we can do this, but we should not."
24
When did we start referring to other human beings as "it?"
3
It is difficult to respond with dispassionate logic to all the parents and relatives posting here, describing their lives with a cherished though handicapped child.
Who does not wish a surviving child to have love, support, compassion and a secure place within its family?
But for every such child, there are many more dumped on institutions for a lifetime--no matter how brief--of profound misery. Others live in horrible conditions with parents--or more likely one parent--who can barely afford to provide the minimum of shelter and food. I saw those children with my own eyes. I worked for a number of years as a tour guide in a children's petting zoo, and many profoundly handicapped children were brought there for an outing. In motorized wheelchairs, hooked up to oxygen, moaning continually throughout a three-hour tour, fed through tubes. Sometimes poorer parents were pushing a non-motorized wheelchair. I saw many caregivers fooling themselves that the children were "enjoying" themselves.
Believe me I knew the difference. I was able to reach children whose caregivers insisted they were unreachable; I recognized when children were suffering profoundly through the outings their parents or caregivers were so invested in having them "experience."
Do not offer survival without also offering a meaningful life without unreasonable suffering.
Who does not wish a surviving child to have love, support, compassion and a secure place within its family?
But for every such child, there are many more dumped on institutions for a lifetime--no matter how brief--of profound misery. Others live in horrible conditions with parents--or more likely one parent--who can barely afford to provide the minimum of shelter and food. I saw those children with my own eyes. I worked for a number of years as a tour guide in a children's petting zoo, and many profoundly handicapped children were brought there for an outing. In motorized wheelchairs, hooked up to oxygen, moaning continually throughout a three-hour tour, fed through tubes. Sometimes poorer parents were pushing a non-motorized wheelchair. I saw many caregivers fooling themselves that the children were "enjoying" themselves.
Believe me I knew the difference. I was able to reach children whose caregivers insisted they were unreachable; I recognized when children were suffering profoundly through the outings their parents or caregivers were so invested in having them "experience."
Do not offer survival without also offering a meaningful life without unreasonable suffering.
26
Who defines a "meaningful life" and "unreasonable suffering"?
5
So as a tour guide there for a few hours, you had a better understanding of these children than their own parents? I have devoted my professional life to these kids but I am by no means the expert on them, only a consultant. The parents are the experts.
5
We do, URNSO2. All of us. The babies can't speak for themselves, can't explain what they are suffering. We have to be compassionate. What many - according to the article, the "vast majority" - are experiencing in these NICUs is a complete horror. It sounds clever to demand "Who defines suffering" etc. but it's actually a question that has an answer.
4
I read this story early this morning, and have been haunted by the moral conundrum. What brings me back to comment are the responses that parse the moral question in terms of money: "Can we afford to try to save these infants? Health care dollars are finite …"
No one's questioning the underlying assumption that money is a greater reality than a human life or the resources to maintain it. We have the knowledge and resources (personnel, equipment) to make the effort to save the extremely premature. Current limitations on those resources are choices: our society supports lots of other stuff that's less important than saving a life. (That this life is statistically likely to face severe physical or mental challenges is the moral conundrum.)
I support legal abortion as a private medical decision. But I've always been concerned about fetal viability, and how medical advantages bring that deadline ever earlier. This profound question may be entangled with the logistics of allocating resources, but determining allocation through profit-and-loss corporate accounting is repugnant. It is, contrary to assertions, NOT the reality. Numbers on a page are not a reality. "Money" is not a reality, not like gravity and the need to breathe: it's a social fiction that enables exchange of resources and services. If money represents what we value as a society, then money needs to facilitate, not restrict and control, what we want to achieve as humans.
No one's questioning the underlying assumption that money is a greater reality than a human life or the resources to maintain it. We have the knowledge and resources (personnel, equipment) to make the effort to save the extremely premature. Current limitations on those resources are choices: our society supports lots of other stuff that's less important than saving a life. (That this life is statistically likely to face severe physical or mental challenges is the moral conundrum.)
I support legal abortion as a private medical decision. But I've always been concerned about fetal viability, and how medical advantages bring that deadline ever earlier. This profound question may be entangled with the logistics of allocating resources, but determining allocation through profit-and-loss corporate accounting is repugnant. It is, contrary to assertions, NOT the reality. Numbers on a page are not a reality. "Money" is not a reality, not like gravity and the need to breathe: it's a social fiction that enables exchange of resources and services. If money represents what we value as a society, then money needs to facilitate, not restrict and control, what we want to achieve as humans.
6
Money most certainly IS a reality when a family of modest means acquires a member who was pulled back from the grave at enormous expense, incubated for months at additional expense, and requires a lifetime of surgeries and other hospitalizations, doctors, therapists, caregivers and special equipment, etc. etc. etc.
And equating money with social value is what got us into this mess, where families cannot bring themselves to say "stop" to futile medical treatment because they're afraid it would look like they don't love their patient.
And equating money with social value is what got us into this mess, where families cannot bring themselves to say "stop" to futile medical treatment because they're afraid it would look like they don't love their patient.
5
I am a fighter for women's rights, especially when it comes to making choices with their body. I believe in abortion and the right to choose. With that being said, I gave birth to a 3 1/2 mo. premie baby weighing 1 lb. 12 oz. who was given only a 7% chance of being born alive. It was day to day torture, not knowing if she would live or die during the 3 1/2 mo. she spent in the hospital. Today she is 29 yrs. old. I have seen a miracle, so I can't help but feel that every premie baby should be given the chance for life where there is hope. Legalize abortion, but set the timeline so low it has not yet formed as a baby.
5
Cheri, are you suggesting a mother should be allowed to abort after 30 weeks?
Science is now revealing that many of these prenatal tests are extremely inaccurate.
They tried to convince my wife to abort when a test came back for Downs Syndrome.
Subsequent testing revealed that the first was a false positive. A local TV report noted that this type of false positive is often never retested and the parents are simply advised to abort based on scientific evidence.
Science is now revealing that many of these prenatal tests are extremely inaccurate.
They tried to convince my wife to abort when a test came back for Downs Syndrome.
Subsequent testing revealed that the first was a false positive. A local TV report noted that this type of false positive is often never retested and the parents are simply advised to abort based on scientific evidence.
1
Maybe a compromise in the abortion debate would go like this:
If you think I can't have an abortion because my fetus might be viable, let them induce labor and you pay for the neonatal care and arrange for the adoption. Oh yes, and pay for the care needed lifelong if there are serious problems.
If you think I can't have an abortion because my fetus might be viable, let them induce labor and you pay for the neonatal care and arrange for the adoption. Oh yes, and pay for the care needed lifelong if there are serious problems.
18
So a quarter of the children in this category will be fine.
To me it highlights the need to better identify the factors that the children who will benefit from treatment share.
To me it highlights the need to better identify the factors that the children who will benefit from treatment share.
7
Our culture has grown ever more obsessed with saving lives, whether that of a highly defective infant, or demented 90 year-old cancer patient with pneumonia. This may be considered a wonderful pursuit by many, however, on deeper levels, it may not be the merciful course of action, and it begs that consideration be given to whatever extending life means for the individual, family and society over long term.
Clearly, nature does not endow every embryo conceived with the means for a long, healthy, and fruitful life which we find a tragic, and it is.
But isn't there a greater good in letting an individual doomed to life locked inside a mind, or without one, something our society should continually facilitate via ever more dramatic, invasive and expensive medical intervention?
Had most of us grown up on a farm or other rural community, I believe the answer to this dilemma would be obvious. Since we've been being born in hospitals, and returning there to die, nature's obvious messages have become obscured.
It is time we Westerners learn (or acknowledge) that we are not immortal nor should we try to pretend we are. We must learn that death is as natural a part of a life cycle as is birth.
Clearly, nature does not endow every embryo conceived with the means for a long, healthy, and fruitful life which we find a tragic, and it is.
But isn't there a greater good in letting an individual doomed to life locked inside a mind, or without one, something our society should continually facilitate via ever more dramatic, invasive and expensive medical intervention?
Had most of us grown up on a farm or other rural community, I believe the answer to this dilemma would be obvious. Since we've been being born in hospitals, and returning there to die, nature's obvious messages have become obscured.
It is time we Westerners learn (or acknowledge) that we are not immortal nor should we try to pretend we are. We must learn that death is as natural a part of a life cycle as is birth.
19
A small percentage? Severe handicaps? Most die? Whatever the number, it's a medical decision for the mother and her doctor, and ONLY them.
12
I think once the fetus is no longer in a woman's body the father should be involved in the decision making if he's going to be involved in the care taking.
1
Once again the NYT failed to provide a balanced assessment in its reporting.
The Times did not provide pictures or anecdotes of even one of the 11 surviving preemies who had moderate, severe or serious impairments.
The Times did not interview any of the parents of the 60 preemies who did not survive where active treatment was given.
The Times did not mention the dollar cost of attempting to save these babies, or who bears that cost.
However, the Times did place the issue of very premature babies squarely in the debate about abortion.
It would seem the Times is pushing a political agenda. Nothing unusual there, though.
The Times did not provide pictures or anecdotes of even one of the 11 surviving preemies who had moderate, severe or serious impairments.
The Times did not interview any of the parents of the 60 preemies who did not survive where active treatment was given.
The Times did not mention the dollar cost of attempting to save these babies, or who bears that cost.
However, the Times did place the issue of very premature babies squarely in the debate about abortion.
It would seem the Times is pushing a political agenda. Nothing unusual there, though.
22
I was a premature baby too and i was born with heart problems and only weighted 2.5 lbs. i also had a twin but my twin was perfectly okay i was the only one with problems and the first 3 years of my life i was covered with cables.
4
It is noteworthy to hear from people who themselves or had family members who survived extreme prematurity, without medical intervention, to become healthy adults.
The lesson from that should be: some premature infants are remarkably tough and healthy. They would not have needed the aggressive interventions now available.
It is also very likely that the actual gestational age is not accurately known in these cases. In a situation where every single day of gestation is a crucial determinant of survival, anecdotal reports are not helpful.
I knew to the moment when conception occurred, because of my physical reaction to the rush of hormones. I told my obstetrician that I would be at full term at the beginning of the following March. He calculated a due date of mid-February. When I was still not in labor by the last week of February he scheduled an induced labor, telling me an "aging" placenta was dangerous to the baby's wellbeing. Thank God in my case all was well and this story is just an amusement for me and my now-adult son.
But certainly a three-week discrepancy in the calculation of actual gestational age is very large. So I would not be heartened by anecdotal reports of exceptional prematurity survived with no harmful effects and leading to a long life.
The lesson from that should be: some premature infants are remarkably tough and healthy. They would not have needed the aggressive interventions now available.
It is also very likely that the actual gestational age is not accurately known in these cases. In a situation where every single day of gestation is a crucial determinant of survival, anecdotal reports are not helpful.
I knew to the moment when conception occurred, because of my physical reaction to the rush of hormones. I told my obstetrician that I would be at full term at the beginning of the following March. He calculated a due date of mid-February. When I was still not in labor by the last week of February he scheduled an induced labor, telling me an "aging" placenta was dangerous to the baby's wellbeing. Thank God in my case all was well and this story is just an amusement for me and my now-adult son.
But certainly a three-week discrepancy in the calculation of actual gestational age is very large. So I would not be heartened by anecdotal reports of exceptional prematurity survived with no harmful effects and leading to a long life.
14
I am in the unique position of having both a 25 year old and a 1 year old. Since you speak of your son as an " adult" I'm wondering how up-to-date your understanding of modern ultra-sonography is. Remarkable advances have been made which allow physicians to pinpoint gestational age with incredible accuracy
4
Td: I was referring to commenters' anecdotes about relatives or themselves, now adult or deceased after a long lifetime, and reported born extremely pre-term. The advances you mention are not relevant to my comment or their stories. I suggest that many of those healthy survivors were further along in-utero than family lore states.
3
So true about mistakes in gestational age. In the past it was fairly common for women to be delivered of robust 7 months preemies (7 months after the wedding, that is!) and everyone celebrated. I wonder how many of the "miracles" in the comments section from older adults are actually from "socially correct" cases?
8
Pertinent to this debate I am the father of a 26 week (who survived and is now 30 years old) and a 22 weeker that did not make it. As biomedical researcher/Professor this experience changed the direction of my work. I set about to decipher the cause of NEC the 2nd leading killer of premature babies. And inded back in 1984 we solved the puzzle - it beign a perfect storm of overly aggressive feeding, immature gut, and the wrong gut bacteria. Essentially a nutrient-gut bacteria interaction. At the time we were heckled at scientific meetings but now the concept is mainstream and with the use of probiotics the incidence and fatality rate as dramatically dropped. Nevertheless I weep for the thousands of babies we lost in the time it took for the medical community to adopt this knowledge. But ALL PARENTS of premature babies owe a massive debt to Dr. Stanley Dudrick the inventor of intravenous nutrition. Without that invention NONE would make it, including my son, who had the opportunity to thank Stan personally. To Stan from all of the greater family of Premature kids - THANK YOU.
36
Beautiful post. As the mother of a former 25-weeker who is now a brilliant, thoughtful infinitely kind 18 year old, I thank you and Dr Dudrick for your efforts to save these babies. Truly heroic work
4
One crucial key to the puzzle is Donor milk. It is life-saving when in comes to NEC - as moms who deliver at an early gestation have trouble with milk supply and pumping.
1
Millions of abortions, annually, notwithstanding.
Only with continued attempts at perfecting neonatal habitat for early humanity, will we ever discover the empirical secrets which can improve the health of future children.
Early Lives Matter!
Only with continued attempts at perfecting neonatal habitat for early humanity, will we ever discover the empirical secrets which can improve the health of future children.
Early Lives Matter!
3
"The study, of thousands of premature births, found that a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues."
"But the authors and other experts also noted that gestational age is an educated guess, based on women’s recollection of their last menstrual period and estimated fetal size."
It seems like these two issues are probably related, and that a way of determining fetal age more accurately might reduce the uncertainties and help people make these very difficult decisions. Not that I have suggestions for how to do this (or that I think it will be easy). It just seems pretty likely that the babies that survive with few problems may also be that small percentage that are significantly older than was thought.
"But the authors and other experts also noted that gestational age is an educated guess, based on women’s recollection of their last menstrual period and estimated fetal size."
It seems like these two issues are probably related, and that a way of determining fetal age more accurately might reduce the uncertainties and help people make these very difficult decisions. Not that I have suggestions for how to do this (or that I think it will be easy). It just seems pretty likely that the babies that survive with few problems may also be that small percentage that are significantly older than was thought.
10
This is a terrible dilemma for everyone. The chances of a baby born at 22 weeks (or even23 or 24) growing up healthy, is small compared to one at 33 weeks (which is still early). The societal impact of the successful survival of very early births is not small. Even barring life-long handicaps from the discussion, the cost of raising 22 week baby to 2 years can easily exceed a couple million dollars. Who pays it?
Still, for the parents involved, the chance that their child will thrive and be happy is there as much as the real possibility of death, disappointment and/or long-term care of a severely handicapped person.
There is no good answer and none I would try to force on anyone. In any individual case, the outcome is unknowable and the choice terrible. The best that can be made of it is to learn the odds of the various eventualities and let the parents make the choice.
Still, for the parents involved, the chance that their child will thrive and be happy is there as much as the real possibility of death, disappointment and/or long-term care of a severely handicapped person.
There is no good answer and none I would try to force on anyone. In any individual case, the outcome is unknowable and the choice terrible. The best that can be made of it is to learn the odds of the various eventualities and let the parents make the choice.
12
Seven of the 78 treated 22 week gestation infants survived without "moderate or severe" medical issues. But as someone in the field, I can confidently say that all of those seven have cognitive deficits. We do not have the technology to allow the human brain to fully mature outside the womb in such early births. According to recent literature, even 35 week gestation babies are at risk for learning deficits. 100 million dollars will be spent in medical resources over 18 years to preserve those 7 individuals when taking into account the 71 who died. We have to decide as a culture whether or not this is a sound ethical and economic choice. I propose that the treatment of 22 week gestation babies is experimental at best.
23
Life is precious.
8
Life is so precious that every day 50k children die from hunger, thirst, and preventable disease.
3
These decisions are personal and the article, and its header, imply that all should 'give it a go' at 22 weeks. Every circumstance is different. To imply otherwise is to imply murder. Shame on you NYT!
7
In 2000, I worked on designing a follow up study until age 4 of premature, low birth weight, less than 1500 grams (3.3 pounds). For many infants, such care was necessary because the incidence of disabilities is far greater in those born too early. The brain develops last so babies born too early can have disabilities lasting a lifetime. After age 2, the infants could no longer get developmental care from hospitals. After age 2, the babies and their parents could only get help from a patchwork of Community Organizations. What care works best for the various disabilities the very premature can suffer? It was not known. Studies following these infants was critical.
I also learned at that time that the cost of premature babies was around $1,000,000, paid for by the parent's health insurance. I do not know what Medicaid paid.
Unfortunately, our grant application was never funded, most likely because of the lack of available money after the dot com bust.
With earlier births the need for valid studies to help the very premature babies and their families becomes ever more necessary.
.
I also learned at that time that the cost of premature babies was around $1,000,000, paid for by the parent's health insurance. I do not know what Medicaid paid.
Unfortunately, our grant application was never funded, most likely because of the lack of available money after the dot com bust.
With earlier births the need for valid studies to help the very premature babies and their families becomes ever more necessary.
.
10
So what? The facts, if facts, bear on the question of abortions only if one believes that life begins earlier than 22 weeks. Jews as Jews, whether Orthodox, Conservative, or Reform, believe that life begins at breach. But some/many Christians want their definition of life to trump Jewish religious belief. So much for their ballyhooed concern about "religious freedom." It is only about religious freedom for some/many Christians and their exercise of bigotry.
12
As a NICU nurse I can tell you that the outcome for the vast majority of 22 week infants is grim. I am upset that , while the article mentions this, it doesn't profile the infants who are profoundly developmentally delayed, blind and deaf. The only personal case scenarios are those who "beat the odds". Nor does the articlediscuss the pain and suffering that these infants are subjected to on a daily basis
42
Yesterday the Times ran an article: "Candidates Fight Over Abortion.."
In the poll results it was found that 30% of Republicans and 20% of Democrats stated that they would rather have the woman DIE than have an abortion, even if that abortion would save her life.
There is the real problem with this article, that nothing will satisfy the anti-abortionists, nothing.
These preemies are simply a means to the end of abortion. They are being used, and those "leading medical groups (that) had already been discussing whether to lower the consensus on the age of viability" are the ones who are using them.
This is cold-blooded and those "medical groups" need to be examined on how many of them are in the 30/20 group and are using these parents and preemies to further their ideology to end lawful abortion.
In the poll results it was found that 30% of Republicans and 20% of Democrats stated that they would rather have the woman DIE than have an abortion, even if that abortion would save her life.
There is the real problem with this article, that nothing will satisfy the anti-abortionists, nothing.
These preemies are simply a means to the end of abortion. They are being used, and those "leading medical groups (that) had already been discussing whether to lower the consensus on the age of viability" are the ones who are using them.
This is cold-blooded and those "medical groups" need to be examined on how many of them are in the 30/20 group and are using these parents and preemies to further their ideology to end lawful abortion.
14
Eventually they'll get it so a fetus could theoretically survive outside the womb in a petri dish from day one. At a cost, of course, of millions, which no one has and no insurance company would want to cover. Yet according to the quasi-logic of this article, that means from day of fertilization a woman will no longer have the right to her own health care and life decisions. She will be an incubator controlled by the State -- an increasingly theocratic State. The contemporary cultural terror of mortality is driving us to a truly mad, totalitarian state.
16
Handmaid's Tale, anyone?
8
An article some years ago described the lifesaving technique used in an impoverished South American region where little pre- and post-natal care was available and where pre-term births of very tiny babies were common.
The mothers were taught to wear their children against their skin, and nurse on demand. The physical warmth of the mother's bodies, and the constant comforting connection between mother and infant, resulted in a surprising number of "miracles."
And I'd think, in the undoubted many cases where infants died anyway, their brief lives were filled with love and reassurance rather than agony and fear.
Of course in our advanced, sophisticated society we could never permit such primitive "treatment" for our very premature babies.
As I have said before, thank God I was spared such a situation. But as a first-time expectant mother at the age of 39 (conceived easily and naturally on the first attempt to have a baby--a miracle in itself), I experienced a great deal of anxiety and soul-searching while waiting for the results of amnio. My then-spouse and I were not in a financial position to care for and raise a potentially handicapped child, God forbid, but I with a living, kicking child within me could not imagine choosing to terminate at that point--by the time amnio results were received in those days, a pregnancy is at four months gestation. (I am a supporter of abortion rights.)
So I viscerally understand that these decisions are not easy.
The mothers were taught to wear their children against their skin, and nurse on demand. The physical warmth of the mother's bodies, and the constant comforting connection between mother and infant, resulted in a surprising number of "miracles."
And I'd think, in the undoubted many cases where infants died anyway, their brief lives were filled with love and reassurance rather than agony and fear.
Of course in our advanced, sophisticated society we could never permit such primitive "treatment" for our very premature babies.
As I have said before, thank God I was spared such a situation. But as a first-time expectant mother at the age of 39 (conceived easily and naturally on the first attempt to have a baby--a miracle in itself), I experienced a great deal of anxiety and soul-searching while waiting for the results of amnio. My then-spouse and I were not in a financial position to care for and raise a potentially handicapped child, God forbid, but I with a living, kicking child within me could not imagine choosing to terminate at that point--by the time amnio results were received in those days, a pregnancy is at four months gestation. (I am a supporter of abortion rights.)
So I viscerally understand that these decisions are not easy.
7
Let's be honest.
The issue we have isn't about the decision to deliver a child at 22 weeks.
The issue is about abortion and setting the point in the development of a child where abortion is not allowed by demand and therefore can only be done for medical reasons.
Setting the viability at 22 weeks then can you justify a abortion at 23 weeks.
You can argue that at present 22 weeks is still early in the development of the child to consider that as the point of viability for all children.
That might be true right now but with the advancements they have made in medical science it is not inconceivable that even before 22 weeks a child can be determined to be viable.
Not all children become viable at the same stage in the pregnancy as some children may become viable after 22 weeks and others after 25 weeks.
If they can do a test that can tell us if a specific child is viable at 22 weeks
then the fact some aren't should not stop us from making abortion for that specific child no longer acceptable by demand.
Even if at present with the technology we have now we should not change the point of viability we know that technology will sometime in the future will justify making that change should we change the abortion laws.
The issue we have isn't about the decision to deliver a child at 22 weeks.
The issue is about abortion and setting the point in the development of a child where abortion is not allowed by demand and therefore can only be done for medical reasons.
Setting the viability at 22 weeks then can you justify a abortion at 23 weeks.
You can argue that at present 22 weeks is still early in the development of the child to consider that as the point of viability for all children.
That might be true right now but with the advancements they have made in medical science it is not inconceivable that even before 22 weeks a child can be determined to be viable.
Not all children become viable at the same stage in the pregnancy as some children may become viable after 22 weeks and others after 25 weeks.
If they can do a test that can tell us if a specific child is viable at 22 weeks
then the fact some aren't should not stop us from making abortion for that specific child no longer acceptable by demand.
Even if at present with the technology we have now we should not change the point of viability we know that technology will sometime in the future will justify making that change should we change the abortion laws.
2
Surviving and thriving are two different sides of this coin. My neonatologist friends are of the the opinion, "Throw them back."
14
It's a rough way to say it but I agree with the sentiment. I'm an old lady. Over 50 years ago I had 2 pregnancies that weren't viable. Back then they were called miscarriages.
2
My son was born at 29 weeks, spent 3 weeks in the NICU and is now a healthy, happy 3 year old little boy. The majority of the babies in the NICU with him were not micro preemies but there were some very, very sick babies. Many of the commenters are spouting off that these micro preemies should not be saved because of the cost or chance of life long disabilities but that is a truly frightening slippery slope. Where do they draw the line? What about a 33 weeker with a severe heart problem? Should doctors assess preemies value to the world and decide that those with possible disabilities should be allowed to die because their possible disabilities make them unworthy of saving.
5
When will those who oppose abortion be the first in line to adopt the unwanted? Hypocrisy dominates the right wing cultures.
14
What happens when technology reaches the point that a human womb is no longer necessary? I suspect that it will in my lifetime.
1
It takes no perspicacity to see where this will go ... as medical technology improves the gestational age at which they can take over the support functions will go down.
The next great step will be the artificial placenta ... the technology to do that is here today ... it is only a certain squeamishness which has delayed it.
Medicine is on the path of delivering what abortion rights activists believe: every embryo could be entitled to life, no natural mother-birth process necessary.
The next great step will be the artificial placenta ... the technology to do that is here today ... it is only a certain squeamishness which has delayed it.
Medicine is on the path of delivering what abortion rights activists believe: every embryo could be entitled to life, no natural mother-birth process necessary.
1
One day at the museum where I volunteer, a family came in pushing an incredibly large...baby carriage. In the carriage was a boy (or maybe girl) who appeared to be about 10 years old. The child was blind and on oxygen, wearing diapers and little else because it was a hot day. The sounds from that carriage made me believe the child could not talk and maybe not hear. I still cringe when I think of the pain and misery involved for the child, the parents and the siblings. Try to save a 12 ounce baby? Why take that chance? Two pictures of extreme premees who happen to be healthy, out of hundreds or thousands living does not make a case. Has being a parent become the ultimate goal for all? Then adopt!
15
If a doctor in the ER receives a case from a car accident with the person having roughly a 1% chance of survival, does that doctor make the call to "not recommend intervention"? How is this a gray area? When did it become acceptable to reject medical help to someone who is helpless? This conversation disturbs me severely.
2
Margaret Sanger is still lives in the liberal progressive democrat collective she helped organize.
1
This is not an Either-Or question. There is a wide spectrum of care to choose from. It's not "Do we provide treatment for the car accident victim or not?" it's "Do we rush into surgery to repair the punctured lungs or do we focus on the head wound because it is causing the most pain? Do we continue trying to shock the heart back into action even though the patient's skin is already burnt, or do we provide what comfort we can and call in the family while nature takes its most likely course?"
With a very premature baby, it's not, "Do we rush in with hundreds of thousands of dollars worth of invasive intervention, or do we let the baby die?"—it's "Do we rush in with extreme intervention or do we stabilize and monitor the patient first, to see if she is strong enough to truly benefit from intensive treatment?"
Either-Or thinking makes for bad policy in any arena, but it creates a special kind of havoc when applied to questions of health care.
With a very premature baby, it's not, "Do we rush in with hundreds of thousands of dollars worth of invasive intervention, or do we let the baby die?"—it's "Do we rush in with extreme intervention or do we stabilize and monitor the patient first, to see if she is strong enough to truly benefit from intensive treatment?"
Either-Or thinking makes for bad policy in any arena, but it creates a special kind of havoc when applied to questions of health care.
2
It's not just "chance of survival" but chance of survival without extreme disability, incompatible with a tolerable life. There are definitely situations where someone (not an infant) has suffered a terrible injury and a decision must be made about whether to take extreme measures to save their life, when the odds are even if they survive they may have severe brain damage. So yeah. It's a gray area.
6
Define "tiny minority."
You have photos of 2 adorable survivors and their parents. Where are the photos of the 90 or more dead, blind, retarded, infected, deaf or intubated premies that these procedures are trying to save? Or the parents who visited a NICU every day for 3 months before their child died? Or the parents who brought home a child that needs round the clock nursing care for the rest of its life?
You have photos of 2 adorable survivors and their parents. Where are the photos of the 90 or more dead, blind, retarded, infected, deaf or intubated premies that these procedures are trying to save? Or the parents who visited a NICU every day for 3 months before their child died? Or the parents who brought home a child that needs round the clock nursing care for the rest of its life?
25
'Aggressive medical intervention' can cost 100,000 + dollars and is by no means effective or guaranteed.
The chances of severe disabilities is high . This is a canard to the right wing and cruel to the parents and children.
The chances of severe disabilities is high . This is a canard to the right wing and cruel to the parents and children.
7
Aggressive medical intervention can cost much, much more than that. I was hospitalized for 3 months and one week. The bill was well over $2,000,000. Yup 2 million.
1
We can't affirm viability at 22 weeks and leave families to fend for themselves. To do so would be immoral. Realize that we are talking very expensive treatments. Even with insurance, I've seen families face extreme financial burdens...even families with insurance.
Too often we debate these ideas of viability and personhood as if they can be completely divorced from the woman who is carrying the child and the difficulty of bringing children into this world. We can agree on efforts to reduce abortions without criminalizing them and without loading up intrusive burdens on ALL women of childbearing age. By pushing the age of viability earlier, doctors feel the need to offer amniocentesis even earlier to women and put healthy fetuses at unnecessary risk ONLY BECAUSE an arbitrary threshold has been set too low. That threshold is already too low.
Thank goodness we can help some of these babies survive out of the womb. Rejoice in the miracles but understand we don't all get happy endings to our pregnancies.
Too often we debate these ideas of viability and personhood as if they can be completely divorced from the woman who is carrying the child and the difficulty of bringing children into this world. We can agree on efforts to reduce abortions without criminalizing them and without loading up intrusive burdens on ALL women of childbearing age. By pushing the age of viability earlier, doctors feel the need to offer amniocentesis even earlier to women and put healthy fetuses at unnecessary risk ONLY BECAUSE an arbitrary threshold has been set too low. That threshold is already too low.
Thank goodness we can help some of these babies survive out of the womb. Rejoice in the miracles but understand we don't all get happy endings to our pregnancies.
5
My sister is a NICU nurse at a well known downtown hospital in St. Louis. Some of her stories about premature birth are very sad. Despite all the medical intervention in the world, when a 22 week baby is born to a drug-addicted mother who already has 5 kids and is living in a homeless shelter, it makes you wonder if the child would be better off without all the medical intervention. Not all premature babies are born to loving, caring parents who practically live at the hospital and are willing to come frequently for skin-to-skin contact, etc.
7
This subject should be addressed after, not before medical care and good educations are provided for existing children living in poverty.
9
So far you have the most compassionate post.
To a poster who wondered, we do not have "death panels" in the Canadian health care system. Neither does the UK.
6
I am a very fortunate person who had parents who really fought for me when I was born at 26 weeks, 30 years ago. At that time, 26 weeks was just on the edge of what doctors would consider capable of surviving.
While the doctors did treat me, they came to my parents multiple times and told them that I would be severely handicapped and should be taken off life support.
I am now 30, in perfect health, have my PhD in science and am married
These preemies are worth fighting for.
While the doctors did treat me, they came to my parents multiple times and told them that I would be severely handicapped and should be taken off life support.
I am now 30, in perfect health, have my PhD in science and am married
These preemies are worth fighting for.
6
There's a *vast* difference in potential outcomes between 22 weeks and 26 weeks.
6
Since you are a scientist, you ought to know that the reason we call outcomes like yours "miracles" is because they are very, very rare.
Every premature baby has its own set of strengths and weaknesses. More often than not the weaknesses are greater and the baby will die. What is the point of "fighting" in that case? It's much more likely that "fighting" through invasive interventions—intubations, IVs, catheters, surgeries—will simply make that very brief life unnecessarily painful, with less opportunity for the parents to provide comfort.
We all want guarantees that the decisions we make are the right ones, but the luxury of having every single pertinent fact in front of us is also exceedingly rare—and even then, we can't know what the future might bring. All any of us can do is make the best decision we can based on the best information we had at the time.
Every premature baby has its own set of strengths and weaknesses. More often than not the weaknesses are greater and the baby will die. What is the point of "fighting" in that case? It's much more likely that "fighting" through invasive interventions—intubations, IVs, catheters, surgeries—will simply make that very brief life unnecessarily painful, with less opportunity for the parents to provide comfort.
We all want guarantees that the decisions we make are the right ones, but the luxury of having every single pertinent fact in front of us is also exceedingly rare—and even then, we can't know what the future might bring. All any of us can do is make the best decision we can based on the best information we had at the time.
12
The *vast* difference between a 22 wker and a 26 wker is enormous! Infants born at 22 weeks have extremely thin and friable skin, that tears at the slightest touch. Their eyes are still fused shut. You can see their hearts beating through the thin walls of their chests. Most likely they have infections, either from their moms during delivery or because they no longer have the sterile womb that keeps their incrediblly fragile bodies protected. There heart continues fetal circulation that needs surgical repair...I could go on and on. An entire month of maturity is the difference between 22wjs and 26 wks!! And the fact that 26 weeks is still 14 weeks early!!
Let's talk about learning ways to PREVENT prematurity!! Let's talk about the enormous financial burden these families will face, and how budget cuts continue to decrease the resources needed for these families.
These discussions dhould not even be in the same category as abortion.
Someone said "life is precious". Yes it is. But what these tiny babies go through is torture! And that's only the beginning for the littlest ones that survive! Not every life is meant to grow to adulthood. And that's a fact of life.
Let's talk about learning ways to PREVENT prematurity!! Let's talk about the enormous financial burden these families will face, and how budget cuts continue to decrease the resources needed for these families.
These discussions dhould not even be in the same category as abortion.
Someone said "life is precious". Yes it is. But what these tiny babies go through is torture! And that's only the beginning for the littlest ones that survive! Not every life is meant to grow to adulthood. And that's a fact of life.
7
OK--NOT a rhetorical question: How much are you willing to pay in taxes to support every required service and facility for these children throughout their lifetimes? That might include income support for parents who must stay home to care for an exceptionally fragile child; remedial and rehabilitative services; group homes if these children survive to profoundly-disabled adulthood; expansion of Medicaid and Medicare for the lifelong medical costs of these children.
Thirty percent tax rate? Forty? The needs of this growing population must compete with everyone else's needs too.
I'd be willing to pay a high tax rate if my own needs as an aging person will be factored in too. If I pay that much in taxes, I will need help in paying for rent and food. Any sort of emergency will devastate me financially.
As a commenter has already noted, the seniors using vast amounts of Medicare dollars have already spent a productive lifetime contributing to society and our government's tax revenues. Perhaps none or few of us have contributed the same amount as we are likely to benefit from. But these babies are entering life with a huge price tag. Few of them are born to wealthy or even upper-middle-class families.
Just keeping them alive isn't enough. We must ensure that their families can provide a reasonable quality of life for them, to the capacity they can experience it.
So how much will you really, actually pay? Get out your worksheets...
Thirty percent tax rate? Forty? The needs of this growing population must compete with everyone else's needs too.
I'd be willing to pay a high tax rate if my own needs as an aging person will be factored in too. If I pay that much in taxes, I will need help in paying for rent and food. Any sort of emergency will devastate me financially.
As a commenter has already noted, the seniors using vast amounts of Medicare dollars have already spent a productive lifetime contributing to society and our government's tax revenues. Perhaps none or few of us have contributed the same amount as we are likely to benefit from. But these babies are entering life with a huge price tag. Few of them are born to wealthy or even upper-middle-class families.
Just keeping them alive isn't enough. We must ensure that their families can provide a reasonable quality of life for them, to the capacity they can experience it.
So how much will you really, actually pay? Get out your worksheets...
11
My first child was modestly premature for reasons completely different from any of the stories portrayed here. It is hard to begrudge a newborn infant a chance at continued life, especially considering the excesses that are routinely justified to allow dying adult patients eke out just a few more weeks or months of life. But parents should be very realistic about these specific examples of good outcomes. They are not the norm. There is so much accumulating research on the benefits of being born bigger and later, and even babies who are born at later gestational dates of 27 through 32 weeks of pregnancy are at much higher risk of lifelong challenges and disabilities, including mental health challenges that arise out of the grueling and unnatural experience of being medically handled and prodded continually in the first months of life. My preemie was born at 34 weeks, relatively healthy, and first two years of her life were still much more grueling than the average new parent experience.
31
Thank you Barbara - your story rings more accurately to the facts than the rosy glasses of many who just want to make lemonade.
2
Having spent my professional life caring for these children long term perhaps I can offer some perspective. Certainly, some of these children endure horrific torture for no purpose and live lives full of pain. I have spent nights crying for these babies, sometimes holding them as they finally passed. Prolongation of life for no reason other than life itself without considering its quality is unconscionable.
However, there is also a distinct tenor to these comments which is frightening. I have devoted my life to caring for children who are "less than perfect" including those with mild to severe problems. This can include all degrees of cerebral palsy, all degrees of learning problems, hearing and sight issues, etc. The number of people who are willing to reduce these lives, which in many cases may be very fulfilling and happy, to not being worth living or even worse, to pure dollar signs, is scary. We have spent many years attempting to overcome bias for the disabled but there is still is, under the surface. Most parents note that in our office is just the only place where their kids are seen primarily as people, not as objects of pity or a burden to be bourn by parents or society. Just remember, all of you are one accident or illness away from being a "burden" on society too.
However, there is also a distinct tenor to these comments which is frightening. I have devoted my life to caring for children who are "less than perfect" including those with mild to severe problems. This can include all degrees of cerebral palsy, all degrees of learning problems, hearing and sight issues, etc. The number of people who are willing to reduce these lives, which in many cases may be very fulfilling and happy, to not being worth living or even worse, to pure dollar signs, is scary. We have spent many years attempting to overcome bias for the disabled but there is still is, under the surface. Most parents note that in our office is just the only place where their kids are seen primarily as people, not as objects of pity or a burden to be bourn by parents or society. Just remember, all of you are one accident or illness away from being a "burden" on society too.
10
Durham MD: It is not pure dollar signs. We are not living in a society where the needs of all are planned for and funded sufficiently to allow not just for the sustainment of life, but a comfortable, well-provided for life in an appropriate setting.
I have seen the distress of aging--sometimes elderly--parents of handicapped adult children who will have no truly safe and loving place to go once those parents die. As any parent of a handicapped child can tell you, without constant parental oversight and involvement, even "excellent" care facilities often fall short.
When saving the life of a very disabled infant, we must consider the entire continuum of its life and how to provide for that. As I have asked in another posting: what tax rate are you actually, truthfully prepared to pay so that we can take care of everyone? The money is not falling from the sky. It is both a moral issue and a practical, real one. Of course we'd have more money for these issues had we not paid for useless wars. But we did pay for them and now have massive debt. We cannot call back those ghostly dollars now.
All of us have seen much-loved, loving and responsive but very handicapped children. I also worked in a recreational facility where I saw many profoundly handicapped, institutionalized children or children merely kept alive, at home, and those children had lives of unrelieved misery. I as a person of deep faith kept asking, as I saw them--why, God, is this permitted to happen?
I have seen the distress of aging--sometimes elderly--parents of handicapped adult children who will have no truly safe and loving place to go once those parents die. As any parent of a handicapped child can tell you, without constant parental oversight and involvement, even "excellent" care facilities often fall short.
When saving the life of a very disabled infant, we must consider the entire continuum of its life and how to provide for that. As I have asked in another posting: what tax rate are you actually, truthfully prepared to pay so that we can take care of everyone? The money is not falling from the sky. It is both a moral issue and a practical, real one. Of course we'd have more money for these issues had we not paid for useless wars. But we did pay for them and now have massive debt. We cannot call back those ghostly dollars now.
All of us have seen much-loved, loving and responsive but very handicapped children. I also worked in a recreational facility where I saw many profoundly handicapped, institutionalized children or children merely kept alive, at home, and those children had lives of unrelieved misery. I as a person of deep faith kept asking, as I saw them--why, God, is this permitted to happen?
4
I don't think it's bias against anyone. It's legitimate, realistic questions about how the care will be paid for, and whether it is really morally okay with us if we expend these resources and yet MANY of them will get nothing out of these measures other than extreme suffering, pain and fear. If we had a crystal ball and we could SEE that this infant will be all right in the long run and this one won't, then we could easily decide that it is "worth it" to provide heroic care to the ones who will make it. But since we don't have a crystal ball, unfortunately we really do have to ask these questions, regardless of all the scolding. It is not a judgment on what anyone's life is worth, or bias against people with disabilities.
3
My husband and I found ourselves in this exact space.
I was pregnant with twins, monochorionic, until about 19 weeks when we discovered the pregnancy had a rare condition causing one twin to be underdeveloped, and to simultaneously endanger the normally-developed twin. To save one, we chose to selectively abort the twin that was causing the issue, in an attempt to save the other. This process involved weeks of hospital visits and strict bed rest.
Within a few weeks, unfortunately, the successful procedure turned into labor in my 22nd week. Our remaining twin was in danger again. After so many weeks in the hospital and on bed rest, and contemplating months more only to give birth to child who would almost certainly die, or if not, to have severe health problems... we gave up on the pregnancy and chose to abort.
The hospital had a policy not to abort after 22 weeks, and at first I could not fathom them telling us that they would force us to try to have the baby when the only outcomes were death or severe health problems. In that hospital, of 5 babies delivered in the 22nd week, 3 died and 2 were severely impaired. I could not believe they were telling us the most they could do was promise death or pain.
They made an exception for us, maybe because we had been through so much already. I hated everything about making that decision, but I think it was the right one for us.
I was pregnant with twins, monochorionic, until about 19 weeks when we discovered the pregnancy had a rare condition causing one twin to be underdeveloped, and to simultaneously endanger the normally-developed twin. To save one, we chose to selectively abort the twin that was causing the issue, in an attempt to save the other. This process involved weeks of hospital visits and strict bed rest.
Within a few weeks, unfortunately, the successful procedure turned into labor in my 22nd week. Our remaining twin was in danger again. After so many weeks in the hospital and on bed rest, and contemplating months more only to give birth to child who would almost certainly die, or if not, to have severe health problems... we gave up on the pregnancy and chose to abort.
The hospital had a policy not to abort after 22 weeks, and at first I could not fathom them telling us that they would force us to try to have the baby when the only outcomes were death or severe health problems. In that hospital, of 5 babies delivered in the 22nd week, 3 died and 2 were severely impaired. I could not believe they were telling us the most they could do was promise death or pain.
They made an exception for us, maybe because we had been through so much already. I hated everything about making that decision, but I think it was the right one for us.
89
Wow that is a huge emotional trauma to go through, and I respect how incredibly difficult that decision must have been for you and your spouse.
AL: I am so sorry for the anguish you experienced. You acted out of deepest love with exceptional courage. I am sure that even the people closest to you have no clue of the depth of your pain and grief. I hope that joy will be granted to you as you go forward.
5
Al, It seems a shame that you had to tussle some, if not push and shove, to finally have your will prevail. Sadly, many, many people are not fully (or even partially) capable of understand their medical circumstances and options. In our great and fair society, who advocates for these?
Who pays the millions of dollars for this fetus to finish developing outside the womb?
Conservatives are quick to point out how expensive it is to keep someone alive in the last year or two or three of their lives and how much that adds to health care costs maybe we should just stop trying.
Well? The costs are the costs regardless of which end of the span the life is on. I'm curious how conservatives make this eugenics-like decision on which lives are worthy of the cost and which aren't.
Conservatives are quick to point out how expensive it is to keep someone alive in the last year or two or three of their lives and how much that adds to health care costs maybe we should just stop trying.
Well? The costs are the costs regardless of which end of the span the life is on. I'm curious how conservatives make this eugenics-like decision on which lives are worthy of the cost and which aren't.
3
My son was born at 24 weeks, and now in childhood has severe disabilities. I understand that cost is a factor in medical policy decisions, but wow – some of these comments are incredibly callous! My son is loved deeply, and his life has value. I hope we will weigh these decisions an understanding that people with all kinds of disabilities can be happy and can contribute to society.
9
So much effort, and--yes--money, spent on learning how to push back the age of fetal viability, and also to extend the life of the very old and infirm, when millions live in abject poverty and ignorance for lack of funds and volunteers. I find it ironic that the very religious are often the first to advocate blocking nature's course.
11
The correct title for this article should have been:
85% of preterm infants born at 22 weeks die or are significantly disabled, even when cared for at the most advanced ICU's.
Maybe if it had included the stories about the parents involved in the overwhelmingly large group of failures despite best treatment the article would have been better balanced. As it stands the article makes an argument that routinely offering care to these infants is a good idea when the statistics show it certainly is not.
85% of preterm infants born at 22 weeks die or are significantly disabled, even when cared for at the most advanced ICU's.
Maybe if it had included the stories about the parents involved in the overwhelmingly large group of failures despite best treatment the article would have been better balanced. As it stands the article makes an argument that routinely offering care to these infants is a good idea when the statistics show it certainly is not.
12
What we're doing is coming closer to creating an artificial womb.
The argument about when life begins is ridiculous. It is based on the concept that we are not a biological organism that develops one cell at a time, but some magical confluence of a blob of flesh and an injection from God. Trying to figure out when that injection happens is meaningless. A newborn doesn't have an adult consciousness, and a fetus doesn't have a newborn consciousness. An embryo does not have a fetal consciousness (or any consciousness, without a brain).
As we come closer to providing an artificial womb, in which eggs fertilized in a lab could be developed into newborns, the "viability" question loses its relevance. If a sperm and an egg are viable, then masturbation and menstruation are murder. Yet, does a sperm have a soul?
When does it become a baby? A question unanswerable by science.
The argument about when life begins is ridiculous. It is based on the concept that we are not a biological organism that develops one cell at a time, but some magical confluence of a blob of flesh and an injection from God. Trying to figure out when that injection happens is meaningless. A newborn doesn't have an adult consciousness, and a fetus doesn't have a newborn consciousness. An embryo does not have a fetal consciousness (or any consciousness, without a brain).
As we come closer to providing an artificial womb, in which eggs fertilized in a lab could be developed into newborns, the "viability" question loses its relevance. If a sperm and an egg are viable, then masturbation and menstruation are murder. Yet, does a sperm have a soul?
When does it become a baby? A question unanswerable by science.
4
My cousin in Boston had a son born prematurely and he is the love of their lives. He is very lucky to have triplet sisters who adore him and treat him just like any normal child. He has excellent care because his mother did her homework and receives special services. He may not be able to do a lot of things that healthy children do but they love him unconditionally. Of course, he is fortunate to have three sisters who will watch over him as he gets older.
We pay millions upon millions in welfare and other social benefits for healthy individuals why not spend a little bit of money to those who are truly deserving of health benefits.
No one is without a disability. Some are just more pronounced than others. To those of us who feel like is sacred this child is a blessing. Just ask this son's family.
We pay millions upon millions in welfare and other social benefits for healthy individuals why not spend a little bit of money to those who are truly deserving of health benefits.
No one is without a disability. Some are just more pronounced than others. To those of us who feel like is sacred this child is a blessing. Just ask this son's family.
5
The article describes a narrow slice of the wider spectrum of how we create new Homo sapiens, referring to the experience of of individuals only and not the principles of human ecology. This gap is huge, and illustrates the dilemma between individual rights and the requirement for those same individuals to defer to the populations' need for restraint .The planet population is now ~7.5 B.
3
There are other ethical questions that will arise if the GOP politicians make across the board judgments based on "a small number of very premature babies surviving" with massive medical intervention available to a few parents. The GOP absolutely will have to offer free health care and excellent neonatal unit availability for all as a top priority as a practical matter for young families. That or more jails for moms who miscarry due to lack of facilities. How about rural women?
Once kids are here they are not going to spend a million dollars to keep them alive and safe, that we already know for sure. Will the facilities for the kids with brain damage be free?
At what point does Mother Nature herself cease to have the authority to suggest a pregnancy is not viable in some of these cases?
Once kids are here they are not going to spend a million dollars to keep them alive and safe, that we already know for sure. Will the facilities for the kids with brain damage be free?
At what point does Mother Nature herself cease to have the authority to suggest a pregnancy is not viable in some of these cases?
7
I was born at 25 weeks -- back in 1955, when neonatal resources were relatively primitive. Nevertheless, after several months in what was then called an incubator and against expectations, I obviously made it -- and with no meaningful defects. The prognosis was so bleak that I was administered last rites of the Roman Catholic Church. As a result, I am a big believer in aggressive treatment, wherever possible.
2
My dad, now 80, was a twin born at home at about seven months. He weighed 2 pounds, 12 ounces; the other twin weighed less than two pounds and only lived about 36 hours. Dad's survival would be unremarkable now but was quite miraculous 80 years ago, when the only intervention available was being placed in the incubator my grandmother used for chicken eggs. My own twins were healthy, both well over six pounds, so I didn't face these terrible issues of premature birth. But I think the question to ask one's physicians is this: what would you do if this were your baby? Treat aggressively, or accept that this child will not survive, or that he will only survive with a severely limited future? I'm a pragmatist myself and would reject heroic measures, but maybe that's my farm background coming out. Not all individuals will thrive, and that's just the way it is.
10
The notion that this recent scientific research surrounding the issue of infant viability/survivability, somehow has implications for the debate on abortion, while true, is for many, information already accepted. Not because those who are against abortion aren't interested in the "laws" of science. but that scientific "laws" are always changing and are inherently limited by what we know at the time. Since scientific "laws" are always evolving and our true understanding of the phenomenon as complex as "viability' is limited at best, one would hope that the benefit of doubt would always err on the side of the unborn.
3
Yes, I'm childless, and yes, I understand the desire that runs so deeply to have a child of your own, but can't we really boil this down to this being about the parents' desires? Some survive with relatively few handicaps--the children mentioned in this story are barely kindergarten age or younger. They may have cognitive or developmental problems that start to present later, during puberty or in middle age. A 2-year follow up study is not the standard in peer reviewed scientific information. I find it extremely selfish to condemn a child to be "one of the sickest babies in intensive care", when the child in question cannot communicate pain, fear, etc. because of their age. I don't think I'd want any child of mind to fight daily for their life for half a year on the solid chance the life they lead could turn out difficult and unforgiving.
9
NICU physicians should have to do a nine week rotation in elementary, middle and high schools that have classes for severely and profoundly handicapped children before they practice medicine. In fact, all doctors should. To see the outcome and consequences of their interventions might give them pause, help them define "harm", and maybe "life" as well. Many of the parents of these children are divorced leaving the mother (woman) to lift, intubate, and diaper adult-sized children for decades at the expense of her other children and her personal life. Responsibility does not stop at the hospital doors and it is the healthcare profession's responsibility to thoughtful and knowledgeably inform families. No way should it be left to hospital social workers to have outcome discussions with families.
76
Yes. "Right to Life" advocates should have to do that as well, and, spend a week caring for those lives they "saved".
3
This is the type of feel good article that speaks about the exceptions but too many infants born early do not fall into this category. This is heart wrenching but does not address the facts of the real costs to keep these children alive and the severe disabilities they may be left with.
All that being said, the real issue is if it were my child or grandchild, it is normal to want their survival.
The alignment with abortion, in this article specifically and in society in general, is quite confusing an another issue entirely.
All that being said, the real issue is if it were my child or grandchild, it is normal to want their survival.
The alignment with abortion, in this article specifically and in society in general, is quite confusing an another issue entirely.
5
So 60 out of 78 (or about 77%) of babies born at 22 weeks of gestation who are treated die. In other words, for each baby who is saved, 3 have to go through the trauma of treatment only to die. I wonder how much trauma and pain they have to go through? I am not sure if it is right or wrong to cause this much pain for a 23% chance of survival, a 9% chance of surviving without serious handicaps. Regardless, I think it must be the parents' choice, but I think the parents must be fully informed not only of the odds, but also about the impact of the treatment.
9
Most families considering abortion around 22 weeks would only be doing so because of a major health problem. You don't allow a pregnancy to go well into the second trimester if it isn't wanted. Any family having to make these kinds of decisions - termination or an incredibly early delivery - is in a heartbreaking situation and I feel only sympathy for them. But this is where medical professionals need to act professionally and recognize the boundaries of medicine vs. nature. I'm glad these families' stories turned out well, but they are definitely the exception, not the rule, and they need to be recognized as that.
8
When I read articles like this, I am reminded of the immense cost and effort we spend on extraordinary care, while many children who were born at near or full term are not afforded the same efforts, research, parental guidance, etc. And I am offended by those who use god to say that their obligation to push for extraordinary care is because god gave them that child. If god was in charge of issues like this, he would have all pregnancies result in full term healthy births. Because "some" births at 22 weeks "might" be viable and the child "might" not suffer debilitating obstacles, does not, in my opinion, warrant the research and medical efforts that might be imposed whether the parents wish it or not. And while I am not saying that if parents CHOOSE to pursue the options offered by modern medicine that they should be denied. However, I believe that it would be better that the research money spent and the social perspectives evolve to take care of the kids who really have a chance. Let's educate and feed those who are at risk because of choices we all make through our government! This article does little except raise hopes for parents who need to make decisions during a moment when their world is crashing down on them that their case with be included in the "some".
7
Insurance companies and hospitals will have to determine how many hundreds of thousands or millions of dollars they are willing to risk on tiny odds of survival. Parents then will turn to government to pay for the additional hundreds of thousands or millions of dollars of intervention treatment/education. The only issue I would have is if parents were now pressured to use extraordinary measures to try to save a severely premature infant, if the decision would be taken out of their hands. Our fairly new ethic of fighting death at all costs not only has high economic costs which are born by all of us, but it also has high costs of the pain and suffering of the infants and parents. The parents should be allowed to decide, but should they be given the choice? I think the neonatal intensive care programs need to review the ethics of the boundaries they are pushing.
5
This is all very interesting, but I wish we could separate it from the abortion issue. It seems to me that the fundamental difference between a fetus and a child is that the mother owns the fetus (and can therefore reject it at will), whereas the mother is responsible for her child (and needs to ensure its well-being, which can include giving it up for adoption). If something is inside your body, you own it, and therefore any choices the mother takes concerning her fetus, at any stage of development, are hers to make. I really do feel that her sovereignty over her body trumps the when-does-life-begin question.
I'm not saying this out of some glib sense of political correctness. Had abortion been a readily available option in the early sixties, I would most likely not exist. Abortion does trouble me on a personal level; I do think it's the taking of a life. But my feelings don't matter. I am not entitled to a say in this issue, even if I am the father of the fetus. The only people entitled to have ethical debates about abortion are pregnant women and their physicians who perform the procedure. The rest of us need to step aside and let them make their difficult choices in peace.
Remember, the reason abortion was legalized in the first place was to SAVE lives. Society recognized that women who wanted them were going to get them by any means necessary, and it was decided that providing the means for women to get them on demand was a public health issue. It still is.
I'm not saying this out of some glib sense of political correctness. Had abortion been a readily available option in the early sixties, I would most likely not exist. Abortion does trouble me on a personal level; I do think it's the taking of a life. But my feelings don't matter. I am not entitled to a say in this issue, even if I am the father of the fetus. The only people entitled to have ethical debates about abortion are pregnant women and their physicians who perform the procedure. The rest of us need to step aside and let them make their difficult choices in peace.
Remember, the reason abortion was legalized in the first place was to SAVE lives. Society recognized that women who wanted them were going to get them by any means necessary, and it was decided that providing the means for women to get them on demand was a public health issue. It still is.
59
My heart goes out to these families. This is such a difficult situation.
There's so much science still doesn't know about the causes of prematurity and long term effects. My water broke at 32 weeks for unknown reasons. I was given steroids and put on bed rest to reach the magical 34 week mark when statistically the baby has a better chance of thriving and chances of infection are minimal. However statistics are really a best guess scenario and my case did not follow the normal case.
My son beat the odds- he was born at 34 weeks and got out of the NICU after 12 days.. As a white male, I was told statistically he would be in the NICU longer. I was also told that statistically he wouldn't have any long term effects. Unfortunately he does and has low muscle tone issues that he is still getting treatment for three years later. No doctors are able to tell us why.
In my case, I came down with a MRSA infection (so much for that statistic!) and was in the hospital for a week after giving birth and had never been so sick in my life.
I'm so thankful for the doctors for the care they gave me and my son. I learned from this so much of this is still unknown. Emotional and financial support is what these families need the most to get through such a difficult time.
There's so much science still doesn't know about the causes of prematurity and long term effects. My water broke at 32 weeks for unknown reasons. I was given steroids and put on bed rest to reach the magical 34 week mark when statistically the baby has a better chance of thriving and chances of infection are minimal. However statistics are really a best guess scenario and my case did not follow the normal case.
My son beat the odds- he was born at 34 weeks and got out of the NICU after 12 days.. As a white male, I was told statistically he would be in the NICU longer. I was also told that statistically he wouldn't have any long term effects. Unfortunately he does and has low muscle tone issues that he is still getting treatment for three years later. No doctors are able to tell us why.
In my case, I came down with a MRSA infection (so much for that statistic!) and was in the hospital for a week after giving birth and had never been so sick in my life.
I'm so thankful for the doctors for the care they gave me and my son. I learned from this so much of this is still unknown. Emotional and financial support is what these families need the most to get through such a difficult time.
5
This is MRS. My now 29-year-old son was born at 30 weeks gestation. While he was in the NICU at Loyola in Maywood, IL, there were children who were earlier into their gestation when they were born. The hospital then, in 1986, knew that 22 weeks was just about the cut-off of viability. When it's your child, you will do whatever you believe is best for your child. My son spent 5 weeks and 1 day in the NICU. Today, he has cerebral palsey, but is not affected intellectually and is not wheel chair-bound but instead uses braces and crutches. Ironically even though he cannot stand or sit well for at least 6 hours in a working day, nor will he ever be able to live unassisted, he does not qualify for SSDI; he is lucky to have found gainful employment, but does not earn enough to have a "living wage." It's a far cry from the morning my ex and I were summoned to the hospital to be told that we should prepare to speak with a mortician. Cerebral palsey has all degrees of damage, so that diagnosis must be monitored over the years. It will have a degenerative affect as a person ages, much like reversal of a polio "cure." Prematurity of any degree can be frightening for any parent. A conscioius decision by parents not to treat a 22-week gestational neonate might result in child endangerment charges if at the wrong hospital. Today, more can be done for a child born that underdeveloped.
2
What about all the women who can't get to a medical center with the ability to treat their 22-week baby? What about those who deliver at home, unexpectedly, as I did at 22 weeks? If 22 or 23 weeks becomes the new limit of viability - but only with heroic measures - they will be devastated by the thought that perhaps their baby could have been one of the tiny percentage who are saved. I'm sure even 24 weeks isn't realistic for many women who have their babies in less than ideal circumstances.
5
Many "Readers' Picks" focus on cost of treatment, and likelihood of failure. Some worry about the "slippery slope" of forcing families to deliver these 22 week entities. These are very reasonable concerns but we face them every day in medicine
-You deliver a 22 week 6 day entity at 1159pm.
-You deliver the same entity 2 minutes later, at 1201am, making it 23 weeks 0 days gestation
(do those two minutes really make a difference biologically?)
-Your child has Down's Syndrome and needs a heart transplant
-Your baby has a seizure and major head bleed after being shaken by the daycare provider
-Your husband has pancreatic cancer (like Steve Jobs)
-Your wife has been shot, and presents with head trauma, brain bleed, and seizure (like Gabrielle Giffords)
-A 6 year old with Attachment Disorder living in permanent foster care has been abused and presents with head trauma, brain bleed, and seizure
-Your father had a heart attack and severe stroke
-Your mother has end stage kidney failure
-A 65 year old with Dementia living in a nursing home with no known relatives has end stage kidney failure.
Do we treat them? Every single one of these patients will cost millions of dollars. Depending on presentation, every single one of them will have life long severe medical issues
Two of them (the Foster care child and Nursing home resident) aren't even "wanted"
You see, medical ethics are complicated, and not as clean and simple as people want them to be.
-You deliver a 22 week 6 day entity at 1159pm.
-You deliver the same entity 2 minutes later, at 1201am, making it 23 weeks 0 days gestation
(do those two minutes really make a difference biologically?)
-Your child has Down's Syndrome and needs a heart transplant
-Your baby has a seizure and major head bleed after being shaken by the daycare provider
-Your husband has pancreatic cancer (like Steve Jobs)
-Your wife has been shot, and presents with head trauma, brain bleed, and seizure (like Gabrielle Giffords)
-A 6 year old with Attachment Disorder living in permanent foster care has been abused and presents with head trauma, brain bleed, and seizure
-Your father had a heart attack and severe stroke
-Your mother has end stage kidney failure
-A 65 year old with Dementia living in a nursing home with no known relatives has end stage kidney failure.
Do we treat them? Every single one of these patients will cost millions of dollars. Depending on presentation, every single one of them will have life long severe medical issues
Two of them (the Foster care child and Nursing home resident) aren't even "wanted"
You see, medical ethics are complicated, and not as clean and simple as people want them to be.
9
I am uncomfortable with this article. The data presented is clearly outweighed by the happy lovely pictures of the exceedingly rare good outcome kids. The emotional message outweighs the facts. This article needed cost data included. And since you cannot present pictures of infants that died or were left handicapped, settle for a graph of the outcomes. And do not picture the warm fuzzy (largely unattainable) good outcomes. The visuals contradict than the facts.
12
A comment on the majority, those severely premature babies who didn't survive. As a pathologist who autopsied many, my heart was so frequently weeping for what these poor tiny babies had had to endure.
21
As a mother and grandmother of girls and women, I have always been pro-choice and this wonderful news about the possibility of life for very young premature babies simply underlines the urgent need for the best healthcare for young women. This is an area where we lag far behind most of the developed world. (The US is 33rd in infant mortality -- a mark of shame for a country as rich as ours). If the standard of care was for every young woman to receive gynecological care, contraceptive counseling, etc. from puberty on, we would not be debating about the viability of very premature babies because women would need and seek second trimester abortions. Then the question of the ultra preemie's viability would be the medical decision it should be.
30
The US has a high infant mortality rate because we try to save micro-preemies with limited success. Many countries do not have neonatologists nor the equipment / drugs necessary to attempt resuscitation thus affecting the all important denominator which is used to determine infant mortality rates. Statistics can be misleading if not taken in context
The humanity of these tiny babies is stunningly apparent in the photo. Human rights for fetuses in utero at 22 weeks and later is a subject the public and the courts may need to take a very close look at.
5
Viability should be determined by the ability to survive with a blanket for warmth and a teat for sustenance. Access to a Category IV neonate unit is not survival outside the womb; it is survival in an artificial womb.
14
It is temporary survival in an artificial womb leading to survival outside the womb.
1
The you would be condemning many children in even the late preterm category, who have 98% + survival, the vast majority of them with normal intelligence and outcomes, to death. Some of these children will likely grow up to care for you as doctors and nurses and caregivers when you yourself are old and unable to do so. Many late preterm babies may not need more than an incubator, or a feeding tube, or some breathing help briefly, but would die without them, and did until relatively recently.
My own full term children, who are very healthy and above average intelligence, as well as myself, a physician, needed more intensive care at birth than you listed due to complications. There is a reason why for most of human history neonatal mortality has been through the roof. Weak or "sickly" babies just tired out and died. Go to a graveyard and look past the past 80 years or so and there will be lots of tiny stones. Who knows what these people could have grown up and accomplished.
My own full term children, who are very healthy and above average intelligence, as well as myself, a physician, needed more intensive care at birth than you listed due to complications. There is a reason why for most of human history neonatal mortality has been through the roof. Weak or "sickly" babies just tired out and died. Go to a graveyard and look past the past 80 years or so and there will be lots of tiny stones. Who knows what these people could have grown up and accomplished.
3
I disagree, I'm not condemning anyone. I don't care what prospective parents elect to do, it should be their choice. As far as I am concerned they can engage in in vitro fertilization and use one of Lois McMaster's proposed uterine replicators to avoid the tribulations of pregnancy altogether.
What I am opposed to doing is using this proposed standard of "possible survival" as the definition of "viability" and the cutoff point for elective abortions. If the baby needs assistance to survive, it is not viable in its current state regardless if it might survive with assistance. Costs also need to be weighed against prospective morbidity and mortality.
What I am opposed to doing is using this proposed standard of "possible survival" as the definition of "viability" and the cutoff point for elective abortions. If the baby needs assistance to survive, it is not viable in its current state regardless if it might survive with assistance. Costs also need to be weighed against prospective morbidity and mortality.
3
A premature, wanted, birth that needs extordinary medical attention should never be confused with a normal early stage potential life, that is not desired by the birth mother, that can be terminated if she so chooses with a simple, legal procedure. Is her survival rate, for the rest of her life, a part of this political equation? We are trying to move goal posts rather than honor the legal rights of women, regardless of what medicine can do at five or six months pre term.
4
But they are fetuses of the same gestation -- one dearly loved and given medical care -- and one cut into pieces, and dumped into a refuse container.
And you don't see any difference there? Does YOUR legal right stop at the point it hurts someone else's legal right?
And you don't see any difference there? Does YOUR legal right stop at the point it hurts someone else's legal right?
1
Your headline on this article is deliberately misleading.
10
I see 4 separate arguments occurring
1. Scientific. Are these entities "viable?" Can (not should) we treat them.
Regardless of your belief structure, the SCIENTIFIC answer is that yes, these 22 week entities are viable, and yes we *can* (not should) treat them. It is incontrovertible because we have living breathing entities delivered before 22 weeks.
Scientific definition of viable: "capable of living; especially: having attained such form and development as to be normally capable of surviving outside the mother's womb." Viability does not mean that there a 100% chance of survival without issues
This barrier will continue to drop. There is no *scientific* reason why we can't succeed with younger entities.
2. Political/Legal. "Can/Must" we treat these entities? Today, the argument is not about *forcing* families to deliver a 22 week entity against their wishes. Today, families are *prevented* from having their 22 week entity treated.
3. Ethical: "Should" we treat these entities?
4. Financial: Can we afford to treat these entities?
The legal/political/ethical arguments are colored by abortion. Many people want to believe these entities are "babies". Others, that it is "just tissue". Neither of these definitions is scientific. Neither term changes the fact that these entities are viable
I'm surprised that NYT commenters would be against doctors giving family accurate scientific information and then allowing that family to make the decision about care.
1. Scientific. Are these entities "viable?" Can (not should) we treat them.
Regardless of your belief structure, the SCIENTIFIC answer is that yes, these 22 week entities are viable, and yes we *can* (not should) treat them. It is incontrovertible because we have living breathing entities delivered before 22 weeks.
Scientific definition of viable: "capable of living; especially: having attained such form and development as to be normally capable of surviving outside the mother's womb." Viability does not mean that there a 100% chance of survival without issues
This barrier will continue to drop. There is no *scientific* reason why we can't succeed with younger entities.
2. Political/Legal. "Can/Must" we treat these entities? Today, the argument is not about *forcing* families to deliver a 22 week entity against their wishes. Today, families are *prevented* from having their 22 week entity treated.
3. Ethical: "Should" we treat these entities?
4. Financial: Can we afford to treat these entities?
The legal/political/ethical arguments are colored by abortion. Many people want to believe these entities are "babies". Others, that it is "just tissue". Neither of these definitions is scientific. Neither term changes the fact that these entities are viable
I'm surprised that NYT commenters would be against doctors giving family accurate scientific information and then allowing that family to make the decision about care.
2
"Regardless of your belief structure, the SCIENTIFIC answer is that yes, these 22 week entities are viable"
That's far from settled. My understanding is that the commonly accepted medical definition of viability is having a *reasonable expectation* of survival. If only an extremely small percentage of 22-week-old infants currently survive, then it's very debatable whether a particular pregnancy is viable.
Viability also involves subjective determinations by a physician, which can vary considerably from one pregnancy to another. (For instance, if there are particular complications or co-morbid conditions that make survival less likely).
That's far from settled. My understanding is that the commonly accepted medical definition of viability is having a *reasonable expectation* of survival. If only an extremely small percentage of 22-week-old infants currently survive, then it's very debatable whether a particular pregnancy is viable.
Viability also involves subjective determinations by a physician, which can vary considerably from one pregnancy to another. (For instance, if there are particular complications or co-morbid conditions that make survival less likely).
Ultimately this becomes a decision that the family in question must make - not one that the state should dictate.
6
As long as they pay for it! If they are having the rest of us pay for it then its everyone's decision.
1
After reading a number of comments concerning this article I would say that the majority of those writing here have logically decided that there are only two options for these children; let them die or kill them.
5
Depressing to read the comments of so many who regard money spent to save the very premature as "a waste of resources." Tell that to the rescuers in Nepal who, against all odds, found survivors days later. Should they have done a profit-and-loss calculation first to see whether peasants would likely ever pay back the cost of their rescue? This is less about money than about abortion, but no one wants to admit that.
5
Dear Diane,
Trying to save 22-week old fetuses is a waste of resources, sorry but it's true. Spending a couple of million per attempt, having at least 2/3 die anyway, having the survivors have major health problems for life, that adds up to each infant that died costing millions and the smaller group that survived costing tens of millions over their lifetimes in medical costs.
Those millions could easily be spent instead on at least tens of thousands of babies per preemie attempt, babies that have easily cured ailments and could be assured of a healthy, enjoyable life. What makes these preemies tens of thousands times more important than other viable children?
Also the rescuers in Nepal were going after people who had a decent chance of survival, and thus it wasn't a waste of resources. But after ten days, it would be a waste, because surviving that long under rubble is a one-in-a-million chance. Just like combing the Pacific floor for that missing Malaysian flight is also now a waste of resources, because we will never find it, and if we find it now the bodies will be gone and the wreckage will tell us nothing.
Trying to save 22-week old fetuses is a waste of resources, sorry but it's true. Spending a couple of million per attempt, having at least 2/3 die anyway, having the survivors have major health problems for life, that adds up to each infant that died costing millions and the smaller group that survived costing tens of millions over their lifetimes in medical costs.
Those millions could easily be spent instead on at least tens of thousands of babies per preemie attempt, babies that have easily cured ailments and could be assured of a healthy, enjoyable life. What makes these preemies tens of thousands times more important than other viable children?
Also the rescuers in Nepal were going after people who had a decent chance of survival, and thus it wasn't a waste of resources. But after ten days, it would be a waste, because surviving that long under rubble is a one-in-a-million chance. Just like combing the Pacific floor for that missing Malaysian flight is also now a waste of resources, because we will never find it, and if we find it now the bodies will be gone and the wreckage will tell us nothing.
3
My kid was born wit only 26.5 weeks... Today he is a perfect boy (without any kind of dreaded sequelae) with 9 years old. After birth, here in Brazil, he spent 56 days in the incubator. They were suffered days but thanks to God everything went wonderfully well. Any questions: [email protected]
4
And in Africa the estimated population will hit 4 billion in a decade or so let alone the rest of the planet. In Yemen the average woman has 8 kids. What are we trying to do here? Is unlimited reproduction a human right? How about lavishing these resources on hungry Yemeni or African kids? How about lavishing these resources on worldwide birth control?
10
Reading this article made me think of the Octomom and the photo of a roomful of triumphant doctors celebrating the fact that they had pulled that one off...wow! 8 Babies! Let's go for 10 next time.
Now where is the Octomom? How are the kids doing? Who's fitting the bill?
Now where is the Octomom? How are the kids doing? Who's fitting the bill?
8
The media is curiously silent, but the last I read she was foreclosed on the home some philanthropist gave her -- was doing stripping to raise money -- and the children were living neglected in chaos.
When social services condemned those kids to live with this fraudster (Octomom) and did not put them into good foster homes, they basically threw the children to the wolves. After all, the Octomom "had rights".
When social services condemned those kids to live with this fraudster (Octomom) and did not put them into good foster homes, they basically threw the children to the wolves. After all, the Octomom "had rights".
2
Little or no mention is made of the suffering of the babies who do not survive, the children who live with debilitating handicaps, and even the suffering of children who survive without disability but spend months on end in the NICU with needles and tubes stuck in their arms and legs.
While many are discussing the monetary cost of offering care to extremely small premies, I believe we must also consider the physical price being paid by all of the children who do not survive. Pictures of smiling toddlers sway our emotions, but for every one of those there are hundreds of babies who suffer unknowable pain and fear with no hope of survival. Would we torture children old enough to speak for such a slim chance of survival?
I do not condemn parents caught in this nightmare, but the hospitals should have a clear humane policy of not treating babies who have little or no chance of survival.
While many are discussing the monetary cost of offering care to extremely small premies, I believe we must also consider the physical price being paid by all of the children who do not survive. Pictures of smiling toddlers sway our emotions, but for every one of those there are hundreds of babies who suffer unknowable pain and fear with no hope of survival. Would we torture children old enough to speak for such a slim chance of survival?
I do not condemn parents caught in this nightmare, but the hospitals should have a clear humane policy of not treating babies who have little or no chance of survival.
14
As someone who was caught in this nightmare, thank you.
Just because we can, doesn't mean we should. Read that first line again, and again. In the heat of the moment we think and say, "Do all you can, just save them!" but in the reality afterwards, we wonder why God let them survive. I'm not just talking preemies, but the critically injured and ill. Parents are not in a position to make an informed unemotional decision when the life they have nurtured is threatened. It should be standard practice at the first few OB/GYN appointments to discuss the "what ifs".
I've been in the position of having to chose treatment, or not. When it was my turn, I had lots of information at hand and a supportive spouse. We chose to let nature determine the outcome of an unexpected renal failure in our then 15 year old, multi-handicapped son. He was eligible for a transplant, but his doctor, his father and I believed he probably would not survive the surgery. We also agreed that to attempt it would deny another child a much better chance at life. We were lucky that time, his kidney function returned and we enjoyed his presence for another 3 years.
Was it easy? Of course not! Was it the right decision for him and for us? Absolutely. Would our friends and society understand? Probably not, but for a child who would never be able to care for himself, would never live an independent life, I like to think he would have agreed.
I've been in the position of having to chose treatment, or not. When it was my turn, I had lots of information at hand and a supportive spouse. We chose to let nature determine the outcome of an unexpected renal failure in our then 15 year old, multi-handicapped son. He was eligible for a transplant, but his doctor, his father and I believed he probably would not survive the surgery. We also agreed that to attempt it would deny another child a much better chance at life. We were lucky that time, his kidney function returned and we enjoyed his presence for another 3 years.
Was it easy? Of course not! Was it the right decision for him and for us? Absolutely. Would our friends and society understand? Probably not, but for a child who would never be able to care for himself, would never live an independent life, I like to think he would have agreed.
12
I worked in a children's hospital in the 80s when the baby doe laws were enacted. You're lucky you had the choice to forego treatment for your son. In those days the reasoning was that of you'd provide treatment for a "normal" child, the same treatment must be provided for a handicapped child, regardless of circumstances. I saw children repeatedly resuscitated, when their quality of life deteriorated with each attempt. Parents were beside themselves with grief, but powerless to stop it. We need to be very careful about enacting laws that take choice and control away from the people who are ultimately responsible for a child.
4
While some success stories can cited, there are many cases wherein premature babies at condemmed to lifelong stuffing.
At this moment, it would seem that fighting nature is a selfish parental choice and a desperate gamble.
At this moment, it would seem that fighting nature is a selfish parental choice and a desperate gamble.
10
My feelings on this subject are closely related to the care of elderly people and those who suffer from other traumatic events, and that is: Just because we CAN do something, doesn't mean we SHOULD do something, and by something I mean life saving medical interventions. The health care team (mainly the physicians) ask the family if they want something done, asking them to make an extremely difficult decision, with extremely limited knowledge. The average American knows very, very, little about the consequences of "keeping people alive". And that is not even monetary. It is quality of life. As an agnostic, the other part of it I find interesting is that people seem to think keeping people alive is "what god wants" when in my mind, god has already spoken, the person is dying and keeping them alive is actually going against what "god" was intending.
13
The costs exceed the benefits not only for the population but for most of the families raising extreme preemies with lifelong disabilities. One miracle, or two, does not represent the whole picture of thousands.
11
Clearly, decisions on very premature births must lie with the parents and their physicians. Why, for God's sake, we allow politicians to have a voice in such agonizing situations is beyond all rationale.
12
Politicians want to allow it because it plays well with the religiosity extremists.
2
Would be nice to hear from parents who grieve, yet are quietly relieved that their extremely premature infants did not survive the extreme treatment of a NICU. A severely handicapped child is a lifelong heartache, not a success.
13
And the reason that I need to pay taxes and higher health insurance costs to fund these medically needy babies is WHAT? So that their parents' vanity can be fulfilled and these children can lead lives of medical misery.
No thank you.
No thank you.
9
It's not vanity! I went into pre-term labor and was put on bed-rest and medication. I and my doctor managed to hold off delivery until close to the due date. There was no reason for the pre-term labor. It was not vanity that weighed on my husband and me every day and night. It was fear. I am amazed at the callousness of all who are commenting here. I think it may be more because of the fear that we will recognize the premature deliveries as babies that are worthy of love and help, then a bunch of flesh that can be thrown away.
2
If you feel so strongly, don't take any insurance subsidy. It's vanity, pure and simple.
1
Children are the future of our unfortunate planet needs to be more resources and save the Baby
2
Great news on one hand, but not on the other in terms of financially liability. The cost of spending nearly 4-5 month in the ICU is a couple of million dollars. Let's hope the child lives up to its worth.
5
Oh! But it's what I want and I want it now! And I don't care how much of other people's lives it costs.
The actions of the mindless pre-mature adults made possible by technology unfettered by reality. Adults make choices. Some of them are hard and uncomfortable.
These are decisions being made by people stealing the life force from others to enable their actions.
"Mam, this child, if it lives, will probably have sever handicaps and will cost millions. Do you have that money or do you need us to go and steal it from others? No? We're sorry,"
Adult lesson on life #1: limited resources.
The actions of the mindless pre-mature adults made possible by technology unfettered by reality. Adults make choices. Some of them are hard and uncomfortable.
These are decisions being made by people stealing the life force from others to enable their actions.
"Mam, this child, if it lives, will probably have sever handicaps and will cost millions. Do you have that money or do you need us to go and steal it from others? No? We're sorry,"
Adult lesson on life #1: limited resources.
12
The appalling incidence of brain bleeds and necrotizing enterocolitis in these infants along with the probability of lifelong disability makes the choice fraught with consequences for infant and parents. I am so glad I never had to face the choice but I would be reluctant to risk my infant's future on the odds.
9
Interesting Karen. Another factor is the medico-legal implications. Brain bleeds and necrotizing enterocolitis are indeed risks of prematurity. If these happen to lead to (and in 50-60% of premature births they do!) cerebral palsy; there will be a plaintiff's lawyer who will claim that there was evidence of fetal distress on the Fetal Heart Monitoring strips and that a c-section should have been done to avoid intra-uterine hypoxia. In NY, there is now a fund for Neurologically Impaired infants; so the taxpayers are bearing much of the costs for these premature births where the physicians did NOTHING wrong; but the insurance carriers are too scared to put the cases in the hands of a jury due to the sympathy factor.
1
it would have been a much more informative article if beside the picture of thecwell child you put pictures of the children with severe cerebral palsy and other severe disabilities languishing in long term care facilites : nursing homes for children
16
Cerebral palsy can happen anytime, not just at premature births.
1
At what cost? One to two million or more in a neonatal unit? Then what will be the long term effects? CP? Learning Disabilities? It is parallel to end of life costs. Where is the discussion on quality of life?
12
One may wonder why many believe why all effort should be made to save a 22-week preemie at a cost of millions (billions if one counts the cost of trying to save all vs the few survivals) - yet want the current health insurance, and any future efforts toward more universal coverage, obliterated.
It seems there were way too few expressions of horror when a child -- or a young adult -- died of tooth infection for lack of funds to pay a dentist or buy the expensive drugs required.
Could it be a matter of 'religion'? An infant must survive birth, to acquire a soul, while the 10-year-old from the poverty side of life is disposable?
Or is it more pragmatic? he hospital can make big money playing god (some of which will come out of all our pockets), but poor folks who need of $80 worth of care (in one child's case) - they should have planned better, worked harder, been smarter, not show up at a hospital wanting a 'handout'.
It seems there were way too few expressions of horror when a child -- or a young adult -- died of tooth infection for lack of funds to pay a dentist or buy the expensive drugs required.
Could it be a matter of 'religion'? An infant must survive birth, to acquire a soul, while the 10-year-old from the poverty side of life is disposable?
Or is it more pragmatic? he hospital can make big money playing god (some of which will come out of all our pockets), but poor folks who need of $80 worth of care (in one child's case) - they should have planned better, worked harder, been smarter, not show up at a hospital wanting a 'handout'.
17
I would like to see more info about the kid who died of the bad tooth. I worked for a dentist, that tooth had to be badly abcessed. Antibiotics are first in line and surgery. Many dentists are not set up for surgery, and why did the parents let it get so bad? There is more to that story then what we heard. But if it fits your narrative, then go with it.
Am I supposed to sit back in awe of the multimillion dollar funneling of money into a life that nature has deemed unfit to live while millions of children in our country go hungry everyday. All in the name of science and "achievement."
This is a very warped culture we live in. Modern medicine left it's ethics and morals at the door at long time ago. Torturing animals for research, keeping anyone alive, be they 22 weeks or 95 years, just because we can is a depraved use of resources which I no longer choose to take part in.
This is a very warped culture we live in. Modern medicine left it's ethics and morals at the door at long time ago. Torturing animals for research, keeping anyone alive, be they 22 weeks or 95 years, just because we can is a depraved use of resources which I no longer choose to take part in.
14
Looks good on paper. What I learned from my daughter who is a graduate student in blind/deaf education at Vanderbilt is that the demand for teachers with her specialty is a direct result of premie births. These children's nerve endings for eyes and ears are not developed. Who pays for this? NICUs are obscenely expensive, these children are often born to the poor and uneducated and dumped into an overwhelmed and underfunded public school system.
73
Actually, Hispanics have better birth outcomes - I would assume you include them in "poor and uneducated." Other commenters here note that many of these births are from women who have had fertility treatment - and that - is very expensive! Need I say more?
Did you mean to imply that such babies matter more if they are born to well-off parents? I hope you didn't. We do not know what causes prematurity. The implication that well-educated parents can keep it from happening is pernicious.
1
Why not just grow them from the beginning in test tubes like in Brave New World? Premature deliveries are definitely not without serious problems and striving for earlier and earlier survivals doesn't seem like good science. This comment is by a suspicious scientist who thinks here the practitioners are pushing the envelope a little too far.
10
Should society, through insurance premiums or taxes or charitable contributions or whatever, be responsible for the lifteime costs of extremely premature children resulting from invitro fertilization of a woman or family who "desparately wants a child"?
12
Like you, I assume, the answer is a resounding "No!"
1
Especially when we already are paying millions or billions to support existing foster children who definitely need homes and mentoring. If people have so much love and nurturing to give, that's a good place to start.
1
Shouldn't we be looking for solutions on how to bring pregnancy to full term? I am a twin, my mother and father were unaware that they were to be parents of twins, nor was the doctor, everyone become aware during delivery. My mother worked at a G.M. factory carrying my sister and myself full term, delivered vaginally. My sister delivered first, myself sixty-five minutes later.
5
Oh dear what a slippery slope indeed! Whatever happened to letting nature take its course?
Until the odds are better these babies are multi-million dollar futile care patients. As a nurse, having taking care of such patients, we are treating the family, not the patient.
I understand everybody hates the thought of losing a baby but it is a fact of life.
Until the odds are better these babies are multi-million dollar futile care patients. As a nurse, having taking care of such patients, we are treating the family, not the patient.
I understand everybody hates the thought of losing a baby but it is a fact of life.
78
"Letting nature take its course?"
I take it you are against abortion.
I take it you are against abortion.
2
You are so correct. Our culture has grown obsessed with saving lives, whether that of a highly defective infant or a senile 90 year-old cancer patient with pneumonia. This may be considered a good thing by many, however, on many levels it may not be the merciful course of action. Bedding consideration be given to whatever extending life means for the individual, family and society over ht long term.
Clearly, nature does not endow every embryo conceived for a long, healthy life, which we find a tragic, because it is.
But isn't there a greater good in letting an individual doomed to l life locked inside a mind, or without out one something our society should continually facilitate via medical intervention?
Had most of us grown up on a farm or other rural community, this would be obvious. Since we've been predominately been born and dying in hospitals, nature's obvious messages have become obscured.
Clearly, nature does not endow every embryo conceived for a long, healthy life, which we find a tragic, because it is.
But isn't there a greater good in letting an individual doomed to l life locked inside a mind, or without out one something our society should continually facilitate via medical intervention?
Had most of us grown up on a farm or other rural community, this would be obvious. Since we've been predominately been born and dying in hospitals, nature's obvious messages have become obscured.
3
The issue is not really whether to treat or not in individual cases as whether this is an appropriate research focus - extending viability back as far as possible. I vote no.
50
Want an idea for a horrorstory? Just film the daily life of a premature (23 weeks) baby in hospital, especially during the moments where no parents are allowed to be present. Such a film sure would make people think better.
11
Come watch my neonatologist "age" right before your own eyes as premature babies are salvaged (somewhat and sometimes) usually with a 99% warranty for an invalid biologic train wreck outcome. For every quasi functional baby story there are hundreds of bad babies with just about every neurological and anatomical affliction imaginable requiring millions each in aftercare once they barely survive. The bad baby data at 26 and 27 weeks is enough to argue "cruel and unusual punishment" without any handson, herioc attempts @ 22 weeks. There are no medical miracles here only bad medicine and idiotic medical ethics.
12
Bad babies?
I'm betting most of their parents don't think so, even if they require help forever.
Cruel and unusual, though, is an argument I can support. These babies feel pain.
I'm betting most of their parents don't think so, even if they require help forever.
Cruel and unusual, though, is an argument I can support. These babies feel pain.
'The point of viability varies according to the state of medical technology, and, again, it is odd to hold that a foetus has a right to life if the pregnant woman lives in London, but not if she lives in New Guinea.' ~ Peter Singer [1]
Singer wrote this in 1995. Twenty years on, it seems that the debate, especially in the USA, is as polarised as ever with the right-to-lifers still locked in a battle to the death with those who insist upon the mother's exclusive right to choose.
My own view, based on pragmatic grounds, is that if it takes a village to raise a child, then the village is entitled to have a say about which human foetuses should or should not progress to full term.
1) 'Abortion'; Peter Singer; In Ted Honderich (ed.), The Oxford Companion to Philosophy, Oxford, 1995, pp. 2-3; http://www.utilitarian.net/singer/by/1995----03.htm
Singer wrote this in 1995. Twenty years on, it seems that the debate, especially in the USA, is as polarised as ever with the right-to-lifers still locked in a battle to the death with those who insist upon the mother's exclusive right to choose.
My own view, based on pragmatic grounds, is that if it takes a village to raise a child, then the village is entitled to have a say about which human foetuses should or should not progress to full term.
1) 'Abortion'; Peter Singer; In Ted Honderich (ed.), The Oxford Companion to Philosophy, Oxford, 1995, pp. 2-3; http://www.utilitarian.net/singer/by/1995----03.htm
3
My own view is that "the village" is not entitled to an opinion. Nor, for that matter, is Peter Singer. He and the villagers do not have a good decision-making history.
And, I say that as someone who does not endorse extreme measures for very, very, very premature infants described in this article.
And, I say that as someone who does not endorse extreme measures for very, very, very premature infants described in this article.
2
Not one word, from the author or from readers, about what intensive, even “agressive” care means for the baby who is undergoing it without the right to choose to die. Where are people’s feelings in this “civilized” world? Is it really love, that makes a mother leave her child in docter’s hands for agressive treatment which simply means prolonged torture? Our rationality really killed our sentiments and our humanity.
8
My late mother had two 20 week old babies, in 1945 and 1955. Both of my sisters thrived and went on to be grandmothers themselves. Yes, Premies need care but it also shows that these babies inside the womb at 20 weeks are people, viable, living beings. So how can we have a conversation about terminating a 20 week old "fetus" on one hand and saving the life of a 20-22 week old baby on the other?
1
Dear Drexel,
I'm sorry but you have been misinformed. There has never been a baby born at 20 weeks that survived. Flat out never, there have only been a couple born right before 22 weeks that lived, and those were miracles of modern technology, definitely impossible in the 40's.
I'm sorry but you have been misinformed. There has never been a baby born at 20 weeks that survived. Flat out never, there have only been a couple born right before 22 weeks that lived, and those were miracles of modern technology, definitely impossible in the 40's.
3
I find that very difficult to believe. Back in those days, operator error / miscalculation re dates is more likely than two living five-month fetuses with no subsequent health problems.
4
Geez, this is something to celebrate. And here we have a bunch of curmudgeons whining away about who pays for it.
3
I'm wondering what efforts we are making to prevent these very premature births in the first place. Rather than arguing about whether a baby born at 23 weeks or a 90 year old with a broken hip should be treated (which? both? neither?) perhaps we should divert more resources to ensuring that more babies are carried to term.
Many years ago when I was having children I was told that we had a very imperfect understanding of why labor starts, and hence, a very limited ability to stop it or prevent it when the time is not right. I assume from the numbers of preemies discussed in this article that we have not yet solved this problem. Because of our increasing skills in keeping very tiny babies alive this is becoming an even more pressing question.
Many years ago when I was having children I was told that we had a very imperfect understanding of why labor starts, and hence, a very limited ability to stop it or prevent it when the time is not right. I assume from the numbers of preemies discussed in this article that we have not yet solved this problem. Because of our increasing skills in keeping very tiny babies alive this is becoming an even more pressing question.
40
When there is Pre term labor or PPROM; (Premature Pre-Term rupture of membranes) there is very little that can be done to stop the birth. The goal at that point is to keep the baby in the womb as long as possible. Tocolytic therapy is given to try to stop contracts and neuroprophylaxis is now the standard of care to help the neonates brain develop. But, once the baby is coming, there is not much to do to stop it.
The March of Dimes is funding research into the causes of prematurity. They have formed partnerships with a few different universities and are asking experts to address the question from many angles. You're correct that it is essential to figure out how labor begins (we still don't know) and how prematurity can be prevented.
2
A good start is sex education in schools, starting in junior high (where none-too-many mothers of preemies come from), including full facts on birth control.
Also, fully funding programs for prenatal care and nutrition. Our country's high premature birth rate is a direct result of inadequate health care for poor women.
Also, fully funding programs for prenatal care and nutrition. Our country's high premature birth rate is a direct result of inadequate health care for poor women.
K was born about the 17th week at ~1.5 lbs. he was breathing and did not turn blue for the first 15+ minutes, but passed about 20 min after birth. The next four babies were ~ 6+ Lbs by the sixth month and each time the doctors insisted they were twins until ultrasound proved otherwise.
Point: Some couples have babies ' early development much more advanced than others. Some babies in the fourth month play vigorous kicking games back and forth--you touch here,they kick here. Then they kick there and wait for you to touch there. Back and forth.
One family I know the boys enter high school with ~90 IQ, graduate at ~100; so the boys go into the woods and mountains for a year, come out about 110, come out of grad or law school at ~24-25 with IQs about 140 and continue to increase over the years. Slow, but excellent, developers.
Ironically he married a lady whose family males usually graduated from med school or law school from 18 to 21. I wonder how their children developed!
Point: development varies and the stages vary. This makes the viable life, abortion, and pain for the unborn yet more complicated.
Maybe ultrasounds before abortion should be required for the medical staff to evaluate but not require to show the mother if an abortion is then scheduled?
By the by, in Thailand's abortions their often is a religious ceremony telling the infant that the mother loves her and will bring her again at a better time. This, even for Americans, seems to greatly reduce PTSD.
Point: Some couples have babies ' early development much more advanced than others. Some babies in the fourth month play vigorous kicking games back and forth--you touch here,they kick here. Then they kick there and wait for you to touch there. Back and forth.
One family I know the boys enter high school with ~90 IQ, graduate at ~100; so the boys go into the woods and mountains for a year, come out about 110, come out of grad or law school at ~24-25 with IQs about 140 and continue to increase over the years. Slow, but excellent, developers.
Ironically he married a lady whose family males usually graduated from med school or law school from 18 to 21. I wonder how their children developed!
Point: development varies and the stages vary. This makes the viable life, abortion, and pain for the unborn yet more complicated.
Maybe ultrasounds before abortion should be required for the medical staff to evaluate but not require to show the mother if an abortion is then scheduled?
By the by, in Thailand's abortions their often is a religious ceremony telling the infant that the mother loves her and will bring her again at a better time. This, even for Americans, seems to greatly reduce PTSD.
1
With the right treatment a cluster of cells can survive. With the right treatment some cells can be instigated to form new beings (as we have seen with Dolly the sheep).
Questions about life should not necessarily be about the quality of life (this is insulting to disabled people who feel they live fine lives) but about presence of personhood. Not potential for personhood, but actual present personhood, which, from how I define a "person," develops sometime after parturition.
From that aspect I think medical attention should be focused more towards actual existing persons rather than potential persons.
Questions about life should not necessarily be about the quality of life (this is insulting to disabled people who feel they live fine lives) but about presence of personhood. Not potential for personhood, but actual present personhood, which, from how I define a "person," develops sometime after parturition.
From that aspect I think medical attention should be focused more towards actual existing persons rather than potential persons.
4
Interesting and rather misleading title for this article. It would have been helpful if the article provided some more information on who paid for the study and the backgrounds of those involved in writing the article. Unfortunately for most readers, we cannot access this information without being subscribers to the medical journal cited.
The results provided in the article are a decidedly mixed bag and don't really support the optimism that anti choice pressure groups will no doubt use it for but who cares we are only talking about women here so...
The long and the short of it is that most premature fetuses would not survive outside the womb.
The results provided in the article are a decidedly mixed bag and don't really support the optimism that anti choice pressure groups will no doubt use it for but who cares we are only talking about women here so...
The long and the short of it is that most premature fetuses would not survive outside the womb.
6
This premise fails to recognize a simple fact: gauging the "age" of a fetus is Not an exact science. A good reason why so many more preterm births do not fare well is most likely a slight miscalculation in gestational age. This focus on "22 weeks" also does not take personal variability into account. Therefore, the best and only determination of viability should rest with the woman (her family) and her physician. Any outside interference is just that outside and interferance. If only we could respect each other more, and assume responsibilty for ourselves, this tiresome debate could be retired.
8
It has recently been reported in the pages of this paper that certain zip codes in the US have infant mortality equal to that of Third World countries--not sure, but I think specifically, Sierra Leone was mentioned. How do we justify spending billions saving barely-viable babies who will almost certainly survive with horrible impairments? Not to mention that many are conceived by the upper-middle class with the help of infertility doctors who have no skin in the game at all. The planet cannot support the population it's got, let nature take its course. Spend the resources on perinatal care instead, our infant and maternal mortality, a measure of societal development all over the world, is a disgrace.
12
I was born in the mid 1980s at barely 26 weeks weighing two pounds five ounces. I had a collapsed lung, and my heart didn't beat for the first five minutes of my life. I had bleeding on the brain. Doctors warned my parents that I would be deaf and severely mentally impaired. I am neither. I graduated at the top of my high school class and cum laude from one of the best colleges in the nation. The reason I am here today is because those doctors gave me a chance. They found a tube small enough to fit inside my lungs to help me breathe and restarted my heart. And even if I had been disabled, my parents would have been overjoyed to have me live. Yes, raising a disabled child is a financial burden, but shouldn't that be the parents' choice? I am reading a lot of thinly veiled disgust towards the disabled in these comments that saddens me. And why can't we have systems in place to take care of the disabled and destitute in this country? If an eight-year-old is in a car accident and becomes a quadriplegic, is she no longer worth saving because she will require expensive care?
49
It's wonderful it worked out for you, R. But there is still an enormous difference between a 6.5 month, 2.5 pound premie and a four month, less than one pound premie. The frightening thing in this article is that hospitals and doctors will feel compelled to "treat" and "save" what are essentially miscarried fetuses.
6
R: Most people aren't "disgusted" by the disabled. But the society of reasonable people ARE appalled at the cost of often lifetime care for the prematurely born. However, they don't argue that it should be stopped, do they?
To argue from the survival of premature babies, who get perhaps a lifetime of expensive compensatory medical care, that this speaks against abortion is nonsensical. Ironically, these people and their elected officials are the very ones now cutting funds to simply feed, clothe and educate those children who are here now, alive now! Calling this behavior hypocritical is being much too kind. Such people are actively destructive of the lives of children whose only crime may be that they are NOT helpless babies but rather the wrong class and therefore don't deserve the society spending money for them! If you want to know what I find disgusting it's people who have little or no compassion for the poor. Talk about anti-Christian!
To argue from the survival of premature babies, who get perhaps a lifetime of expensive compensatory medical care, that this speaks against abortion is nonsensical. Ironically, these people and their elected officials are the very ones now cutting funds to simply feed, clothe and educate those children who are here now, alive now! Calling this behavior hypocritical is being much too kind. Such people are actively destructive of the lives of children whose only crime may be that they are NOT helpless babies but rather the wrong class and therefore don't deserve the society spending money for them! If you want to know what I find disgusting it's people who have little or no compassion for the poor. Talk about anti-Christian!
4
An eight year old is a person. She has a functional central nervous system. She has relationships with others, she has thoughts. A 22 month fetus us not a person. If have yet to see a full term baby who had a functional nervous system. It takes a least a year before they have the semblance of a thought. A fetus does not think therefore it is not.
3
Our son was born at 28 weeks almost 40 years ago. He survived when the medical prevailing wisdom was that "28-weekers" didn't.
Now we're talking about real chances for 24 weeks gestation and pushing the limits down further to 22 weeks.
On the other hand, our developmental disabilities agency is alerted by the hospital whenever a child is born weighing below 1500 grams (3.3 lbs). I'm sure that figure hasn't come down for decades. That agency may at least inform the parents of where to go for help if their child experiences developmental delays.
The point is that all premature births have a higher-than-average rate of any number of developmental problems, from retardation to stroke. Yet we wouldn't think of setting a bar across a certain definitive line, whether that line be cost or the various levels of struggles the child may have to endure over a lifetime, tying the hands of doctors and parents.
All babies born healthy will have costs too, a lot of them. How much does it cost to raise a child to age 18? I'm sure I spent a similar amount for our son.
Now we're talking about real chances for 24 weeks gestation and pushing the limits down further to 22 weeks.
On the other hand, our developmental disabilities agency is alerted by the hospital whenever a child is born weighing below 1500 grams (3.3 lbs). I'm sure that figure hasn't come down for decades. That agency may at least inform the parents of where to go for help if their child experiences developmental delays.
The point is that all premature births have a higher-than-average rate of any number of developmental problems, from retardation to stroke. Yet we wouldn't think of setting a bar across a certain definitive line, whether that line be cost or the various levels of struggles the child may have to endure over a lifetime, tying the hands of doctors and parents.
All babies born healthy will have costs too, a lot of them. How much does it cost to raise a child to age 18? I'm sure I spent a similar amount for our son.
8
I was born at 25 weeks and weighed in at 2 lbs 12 oz. In 1955! I was given last rites of the Catholic Church given I was not expected to thrive. Yet after several months in what was then called an 'incubator' I clearly pulled through -- and with no meaningful defects or developmental problems. I suppose I'm a bit of a miracle.
2
Edward - you make extremely cogent points. But, the odds of adversity are being glibly glossed over more often than not by those who are the lucky side of the equation.
1
My great maternal grandmother worked and lived in the city of Flint as a licensed nurse, and unlicensed midwife. The period of time was in the early part, through the mid 20th century. Her daughter my maternal grandmother was born weighing less than three pounds. She was swaddled and kept warm in a shoe box on the oven door. She lived until the age of 80.
Her daughter, my mother gave birth to my twin sister and myself, full term, 5'6 and 5'8 ounces, vaginal birth at St. Joe's in Flint. It was not determined that my mother was carrying twins until my twin was delivered, and 65 minutes later I arrived, vaginal deliveries.
My mother worked at a G.M. factory right up until the day of my sister's and my birth. My dad worked at the same factory, and they had one child at that time, whose birth was a difficult breech delivery, with subsequent complications for my mother.
What is important to prepare parents is pregnancy is normal, and healthy, and preventive measures should be part of carrying a child to full-term.
Her daughter, my mother gave birth to my twin sister and myself, full term, 5'6 and 5'8 ounces, vaginal birth at St. Joe's in Flint. It was not determined that my mother was carrying twins until my twin was delivered, and 65 minutes later I arrived, vaginal deliveries.
My mother worked at a G.M. factory right up until the day of my sister's and my birth. My dad worked at the same factory, and they had one child at that time, whose birth was a difficult breech delivery, with subsequent complications for my mother.
What is important to prepare parents is pregnancy is normal, and healthy, and preventive measures should be part of carrying a child to full-term.
1
I spent the vast majority of my nursing career working in obstetrics, primarily in high level antepartum, labor and delivery. While I have seen viability go from approximately 28-32 weeks down to the current 23-24 weeks, the primary stumbling block with virtually no improvement has been the ability to prevent premature delivery. Magnesium sulfate is the primary treatment for delaying delivery, usually only effective for hoping to get 48 hours, long enough to get steroids on board to help with fetal lung maturity. And the oxymoronic reason for so little progress in a medical/pharmaceutical development of treatment for premature labor is the possible liability for fetal harm. If we could treat and prevent premature delivery we could possibly eliminate much of the moral/ethical cloud surrounding treatment of extreme prematurity. The mother still remains the best incubator.
4
Isn't neuroprophylaxis for brain development and not a tocolytic? Isn't the main treatment something like terbutaline? I think you are a bit confused.
22 weeks for birth and survival is ridiculous. Not exactly a medical achievement I'd boast about. The fetus can be less than 1 pound and has barely developed its eyes and lips at this point. Think the size of a papaya fruit.
Such extraordinary measures should not be taken. Just because you can do something medically doesn't mean you should. It's immoral to put that emotional, physical, and financial strain on the fetus and the parents given the mostly negative outcomes of such an underdeveloped fetus. Parents of extreme premies should be counseled at length about the likely health outcomes/costs and should have the right to refuse extraordinary measures for premie births.
Why are people so eager to force life when it is off to such a bad start?
Such extraordinary measures should not be taken. Just because you can do something medically doesn't mean you should. It's immoral to put that emotional, physical, and financial strain on the fetus and the parents given the mostly negative outcomes of such an underdeveloped fetus. Parents of extreme premies should be counseled at length about the likely health outcomes/costs and should have the right to refuse extraordinary measures for premie births.
Why are people so eager to force life when it is off to such a bad start?
16
How do we distinguish between a very premature delivery and a miscarriage? I had an early miscarriage. The process felt like a fairly easy labor, complete with contractions, and then I delivered a very small placenta. Obviously something was wrong with the baby, which was why I miscarried.
It seems like an important distinction. Is it a late miscarriage, which suggests that something was wrong, or a very early delivery?
It seems like an important distinction. Is it a late miscarriage, which suggests that something was wrong, or a very early delivery?
60
By what medical criteria might we distinguish between a late miscarriage and a very early delivery? I am not a physician, much less an obstetrician, but I would bet a large sum that there is no bright line between these two situations.
My understanding is that after 20 weeks, it's no longer a miscarriage.
"Miscarriage" is a term applied to pregnancies that end before 20 weeks. I'm sorry for your loss, but having an early miscarriage does not give you the authority to speak from experience on preterm deliveries.
We commenters clearly see a fundamental problem with medical policy in America that the Times is blind to as noted recently by Times writer, Paul Krugman.
Here we read about what I will call "saving a life at any cost", using the phrase realizing full well that the parents whose 22 month old has been saved might say, "You cannot put a cost on the life of my baby."
But then read this from the Bulletin of the World Health Organization 2015;93:135
"Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA). Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births and the country has now a higher ratio than those reported for most high-income countries and the Islamic Republic of Iran, Libya and Turkey. About half of all maternal deaths in the USA are preventable."
Personalized medicine at any cost is not needed to prevent these maternal deaths. The WHO report us a perfect complement to Paul Krugman's "Race, Class, and Neglect" May 4. Take another look, then ask him to write the followup to that column
Only-NeverInSweden.blogspot.com
Here we read about what I will call "saving a life at any cost", using the phrase realizing full well that the parents whose 22 month old has been saved might say, "You cannot put a cost on the life of my baby."
But then read this from the Bulletin of the World Health Organization 2015;93:135
"Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA). Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births and the country has now a higher ratio than those reported for most high-income countries and the Islamic Republic of Iran, Libya and Turkey. About half of all maternal deaths in the USA are preventable."
Personalized medicine at any cost is not needed to prevent these maternal deaths. The WHO report us a perfect complement to Paul Krugman's "Race, Class, and Neglect" May 4. Take another look, then ask him to write the followup to that column
Only-NeverInSweden.blogspot.com
8
Someone here made an excellent point: the actual cost of treating these babies is very different from what the hospitals charge for that care.
This is a point which should be driven home again and again. The cost is different from the charges we are billed for medical care.
This is a point which should be driven home again and again. The cost is different from the charges we are billed for medical care.
5
Let's get up out of the box of who's to survive and who isn't. We are a culture caught in conflicting beliefs. We need to move past belief and learn how to look to see what is, not what we insist upon. Policies are permanent solutions to temporary problems. We're saving lives because we were taught to believe in the "right" or "moral" or "compassionate" thing to do. But look around. Life and death are the natural order of things. We have been denying that for the last century. Now the planet has almost four times as many people on it as when that century began. Can we continue to live by our policies?
7
In regards to Roe v Wade, which protects a woman's right to choose abortion within the first trimester, 22 weeks still remains beyond that benchmark, rendering the findings irrelevant. Misleading studies shouldn't infringe upon a fundamental human right.
13
Let's start with some missing data. In 2013, there were 3,932,181 births. If 5,000 were 22 or 23 week old premies, most of us can do the math. The average cost for infants hospitalized in neonatal intensive care units is around $3,000 per day. A larger question is how much adequate prenatal advice to mothers would reduce premature birth. I suspect strongly that adequate prenatal care would be much more effective in reducing premature birth. For the religious, the question is also ethical. How much do we want doctors to play God? Any time prior to 10 years ago, the question in the article would be meaningless.
7
That " the vast majority died or suffered serious health issues" is to me a frightening factor in the determination to keep babies alive at any cost. Highlighting the exceptional success is so misleading. You can compare this to the other end of life - where families or Drs. - may choose to prolong life without regard for what that actually means. And I hate to bring it up - but what does it cost? And what does it cost in long term care? I have met families where the stress broke up the marriage and adversely affected other children. Perhaps there should be some visits with technology dependent children and their families to see what can happen when intense efforts to keep an infant alive at all costs do just that and only that.
This like other areas of so-called health care needs scrutiny. For parents it is a cruel choice, as if they have to accept the intervention or be responsible for the child's death. That is terrible. But it must be subject to some rational assessment.
This like other areas of so-called health care needs scrutiny. For parents it is a cruel choice, as if they have to accept the intervention or be responsible for the child's death. That is terrible. But it must be subject to some rational assessment.
52
To me, a lot of the discussion is just the noise, with the signal being the issue of our attitude towards the family, including the baby delivered. From my point of view, and unfortunately I've been there and done that, it's the love and support that make the difference, regardless of treatment and outcome. The neonatologist who expressed such compassion with his eyes while he was communicating that our preemie would not survive, I had a better experience of than I had of many friends and family members, and for me, the issue was more about trauma and less about a "fix it" problem. I believe that if we paid more attention to how we handle families during crises like these, we would reduce the tension over issues such as cost and resources, similar to the way we find when we introduce high quality hospice-style care at the end of life. And I don't just mean the people who are working in the hospital, in terms of "how we handle families ...," but all of us outside the hospital too.
20
That sounds great, but unfortunately handling the family and being sensitive and all, whether in the hospital or in the wider culture, won't change the overarching issues of the need for health care reform (single-payer) and it won't make the hard questions about allocation of resources go away.
1
Just because we can do something that does mean that always mean that we should? We are able to keep preemies alive but what if that means that they will have health issues or disabilities for the rest of their lives. Or need care for the rest of their lives? Same with the elderly. We can keep many aged people alive much longer than ever before but should we? Many elderly patients in their 90s are being prescribed statins to reduce cholesterol. Is this really necessary? Do we not recognize natural death anymore?
117
In Canada, or the U.K. - any place where medical care is the government's responsibility - the answer is no. To maintain the viability of the system, sacrifices and choices need to be made. In Canada, the choice you describe, has already been made. As it is not cost effective to save premature babies, or the very elderly, I expect the Canadian NHS does not do so, relieving patients or their caregivers of the burden of choosing whether to live or die. In the United States, it is ironic that liberal opinion on the abortion question, is strongly pro-choice (i.e. woman and doctor empowered to terminate pregnancy without any state interference), and at the same time, very willing to cede all health care delivery to the government (such that the government will have no control over a women's fetus, but entire control over the woman's own life).
1
The amount of care and the dubious outcomes in terms of disabilities makes this a strong case for recognizing the limits of wisdom. We ration health care for the poor by simply not providing it and think nothing of it. We treat the elderly terribly by leaving them to die of neglect in inadequately staffed nursing homes, but we are willing to expend all sort of care to assure a 22-week gestation fetus survives? Yes, the parents will mourn the loss of the baby-to-be, but the families of homeless people dying on our pavements are also mourned as are the elderly who die of neglect. Death, folks, is part of life. Let's put our efforts and resources in to caring for the living.
6
"do we not recognize natural death anymore?"
obviously not soon enough ibivi...
...not soon enough....
obviously not soon enough ibivi...
...not soon enough....
Unlike the article, and so many intelligent commenters here, there may be a solution to the dilemma of the choice.
The most basic dilemma is cost. "I'll pay anything to save the infant's life!"
No. No you won't. The cost is two fold only about 10% survive to a fairly normal life. Another 10% survive, but will need a lifetime of care afterward.
The cost of any attempt is in the millions of dollars. If the dollars spent are put up beside just the successful outcomes,,, the cost is hundreds of millions per that successful 10%. Per child. A hundred million dollars to save one infant. That is daunting.
The way to do it. My Great Grandmother in law,, a truly great lady. that title was absolutely appropriate for her.
When the twins in 1899 were born so very premature, delivery was in the parlor, physician attended. The two were placed on the side board. neither expected to live. But one continued to cry, the other , expected silence. After some hours, the crying infant was cradled to a breast, and she did thrive.
Do not, do not go immediately into life saving extreme measures, allow nature,, for some, allow your God to make a choice. And then if so,,, feed the infant, cuddle,,, do not intervene for 24 hours.
Reasonable, less expensive, and right. If someone wants extreme measures from the get go,,,, tell them to open their wallet,,, you'd be glad to do that for them. They pay the fare.
The most basic dilemma is cost. "I'll pay anything to save the infant's life!"
No. No you won't. The cost is two fold only about 10% survive to a fairly normal life. Another 10% survive, but will need a lifetime of care afterward.
The cost of any attempt is in the millions of dollars. If the dollars spent are put up beside just the successful outcomes,,, the cost is hundreds of millions per that successful 10%. Per child. A hundred million dollars to save one infant. That is daunting.
The way to do it. My Great Grandmother in law,, a truly great lady. that title was absolutely appropriate for her.
When the twins in 1899 were born so very premature, delivery was in the parlor, physician attended. The two were placed on the side board. neither expected to live. But one continued to cry, the other , expected silence. After some hours, the crying infant was cradled to a breast, and she did thrive.
Do not, do not go immediately into life saving extreme measures, allow nature,, for some, allow your God to make a choice. And then if so,,, feed the infant, cuddle,,, do not intervene for 24 hours.
Reasonable, less expensive, and right. If someone wants extreme measures from the get go,,,, tell them to open their wallet,,, you'd be glad to do that for them. They pay the fare.
70
What a horrible story. A newborn was left to cry for hours instead of being cradled by its mother. This child's twin was laid out to die alone instead of being held.
It doesn't matter if our life is an hour or a hundred years. We deserve to be held and loved.
It doesn't matter if our life is an hour or a hundred years. We deserve to be held and loved.
5
Slick, but why not let nature present in an equally compelling way by lettings us make up our own minds about our own children.
1
To be fair, though, they didn't "set the twins on a sideboard" in 1899 because they had some greater wisdom about life and death. They didn't have any other options available to them.
1
Every day we spend billions on end of life care for people that have already been alive for 60, 70 80 years. Then people don't want to spend resources on a 22 week old baby. Watch what happens when 90 year old grandma breaks hip and needs surgery and rehab and dialysis. No expense is spared.
Ridiculous. Plus the cost of treating these babies is very very different than the charges.
Ridiculous. Plus the cost of treating these babies is very very different than the charges.
19
Not 22 week old babies! 22 weeks' gestational fetuses! No one anywhere is advocating withholding medical care from 22 week old infants.
6
You are right about the elderly receiving extreme treatment in their final years. My sister and I thought differently. Our mom received all the medications and care she needed until she fell and broke her hip at 95. She had just started treatment with Hospice for failure to thrive. There was no question about having surgery. She was given morphine drip for the remaining week of her life. Some people were surprised we didn't opt for surgery but she had dementia and had already lost her will to live. I think the same is true for preemies. I agree with the commenter who quoted her great grandmother. Let them be for at least the first 24 to 48 hours to see how they do, then decide on treatment.
4
It's the same situation at both ends: Elderly people and premature babies whose care costs insane amounts of money, who are not going to recover and go on to live long, healthy lives. Meanwhile, millions in the middle go without the most basic care.
Sorry, that's nuts.
Sorry, that's nuts.
2
Roe v. Wade defines viability as the point where the fetus "is potentially able to live outside the mother's womb, albeit with artificial aid." As a lawyer and a pro-choice advocate, it nonetheless seems to me that the word "potentially" covers instances where there is a 1 in 4 chance of survival, so that the age of viability is almost certain to be pushed forward to 23 weeks based on the research discussed here.
16
Tell that to my two sisters who were born at 20 weeks back in 1945 and 1955 when medical care was a shadow of what it is today.
At what stage will doctors agree to do a C section with the legitimate hope that the baby will be viable? If that stage is 22 weeks, let the Mom elect for that early removal, why not? But if this new "viability" is simply a slim chance that the fetus is a baby, then by reducing the abortion window while not allowing for early C sections, you have made a woman into an incubator. If women who wish to abort are forced instead to carry these "viable" fetuses to term, what's the logic there? I don't understand it. I doubt very much that you could find an obstetrician who will do a C section at 22 weeks. Because they know the baby is not actually viable in any common sense of the term. Women as involuntary incubators, at least they should be paid the equivalent of the avoided NICU cost for the final five months of the pregnancy.
2
This article is severely misleading for parents because the few happy results are graphically displayed while the normal bad results are just numbers: 78 babies born at 22 weeks were treated and 60 (77%) died anyway. Of the 18 that lived 7 (9% of the 78) were normal, the others (14% of the 78) were handicapped, some of them severely. Raising a handicapped child takes a lot more time and involves suffering for parents and child. it's not just about money. The parents have a right to know their chances of having a handicapped child and the range of handicaps that normally occur. Some parents could deal with it, others couldn't. It should be their decision to treat or not - a private decision without having judgment visited upon them.
Since the numbers are so poor (9% normal at 22 weeks and 17% normal at 23 weeks) cold logic suggests that parents who have no reason to expect a problem next time should not treat. But people are not logical about children - still they should have all the information. The issue will also be politicized due to the abortion issue and the huge costs of treatment and lifelong support for handicapped survivors. As if premature birth weren't agonizing enough.
Since the numbers are so poor (9% normal at 22 weeks and 17% normal at 23 weeks) cold logic suggests that parents who have no reason to expect a problem next time should not treat. But people are not logical about children - still they should have all the information. The issue will also be politicized due to the abortion issue and the huge costs of treatment and lifelong support for handicapped survivors. As if premature birth weren't agonizing enough.
111
I have heard a collective cry to abolish the death penalty and save one innocent life from an unjust ending. Where does your cry begin?
3
Actually, I found the article misleading in the other direction. 7 healthy survivors out of 78 treated is not a "tiny minority" as the lede states. "Small percentage" would be more accurate.
Additionally, it is very difficult for parents to visualize what it means to care over many years' time for a child with severe developmental disabilities. It is easy to understand the desperation of parents who, at birth, will say, "Do anything, just save my baby." And it can be relatively easy to care for a disabled newborn, infant, toddler (stress on the word 'relatively'). But it's a whole other situation caring for that child as they grow older; a severely disabled teen and young adult presents only more and more extremely difficult challenges, from lifting, bathing, diapering to worrying about what they will do when mandatory schooling ends and then who will care for them when their parents die. Our society is not yet set up to provide all the necessary supports for severely disabled people as they age.
5
I have worked at several hospitals where high risk deliveries are done and seen amazing successes, dismally damaged survivors, and numerous deaths of children born extremely early. Though the definition has shifted downward in the last four decades, the extreme preemies who do survive, often endure weeks and months of unstable, brittle existence, with many crises, drugs, artificial ventilation, surgeries and resuscitations. Parents may be asked to decide whether to treat brain hemorrhage, sepsis, necrotic bowel, seizures, pneumonia, pulmonary hypertension and more. The N-ICU experience for baby and parent of such an infant can be a series of nightmares and emergency decisions, for which there is no preparation. In one hospital where I worked, before surfactant, the policy was to deny resuscitation to babies under, then, 24 weeks. If born alive, they were simply placed in a warmer and allowed to rest. If they stabilized in 24 h with this minimum treatment, they were then given all support. Most who survived did well. Perhaps hospitals should now offer soft support, with surfactant and oxygen only, for the first 24 hours to this very fragile group. Those who do well are probably the 25% who survive with aggressive treatment. We could se rest weeks of agony before death and the parents, weeks of psychological torment.
109
This comment was well-stated. The critical challenge for these threshold of viability decisions is the inherent variability of human development, i.e., there is no perfect algorithm for what a human baby is capable of at a specific gestational age. "Term" is defined as 37 weeks gestation. I can almost guarantee that all NICU nurses have seen at least one 37-weeker in their career that had immature lungs and severe respiratory disease. This is why the chances of intact survival are so rare at 22-23 weeks.
Having had direct experience in clinical care at the pinnacle of medical institutions, if there is an example of technology and ideology run amok while wasting vast resources, this is it.
Most parents have no idea of what goes on and what is to come. What they do have is a bubble of hope and the neonatology staff loathe to puncture it by telling the truth. The reason is simple. Their raison d’être (for idealists) and/or pay (for pragmatists) are tied to days of survival, not the eventual functionality what the public would deem as human. Once the child is out of the NICU, they are completely dissociated from any caregiving.
A true story: a 420gm (less than a pound) premie born to parents of grammar school education airlifted across the country. The head lit up like an orange bulb when a flashlight was placed at the temple. At least 10 operations over the next 18-24 months required just to keep “it” viable. That was a hint to the most engrossing topic during rounds that morning---should we make it a girl or a boy?
If the kid survives to toddler age, the parents have already invested virtually all of their resources for years, often at the neglect of their other kids, and have over time become fierce defenders. Only the objectively reflective ones will concede that they should have let go but they still carry on valiantly. By that time, one can only sympathize with their devotion.
Sometimes playing God is cloaked in fighting Mother Nature.
Most parents have no idea of what goes on and what is to come. What they do have is a bubble of hope and the neonatology staff loathe to puncture it by telling the truth. The reason is simple. Their raison d’être (for idealists) and/or pay (for pragmatists) are tied to days of survival, not the eventual functionality what the public would deem as human. Once the child is out of the NICU, they are completely dissociated from any caregiving.
A true story: a 420gm (less than a pound) premie born to parents of grammar school education airlifted across the country. The head lit up like an orange bulb when a flashlight was placed at the temple. At least 10 operations over the next 18-24 months required just to keep “it” viable. That was a hint to the most engrossing topic during rounds that morning---should we make it a girl or a boy?
If the kid survives to toddler age, the parents have already invested virtually all of their resources for years, often at the neglect of their other kids, and have over time become fierce defenders. Only the objectively reflective ones will concede that they should have let go but they still carry on valiantly. By that time, one can only sympathize with their devotion.
Sometimes playing God is cloaked in fighting Mother Nature.
122
I'd like to reiterate something here that is probably being overlooked by most, including me.
From Liz, Seattle, WA
"We should accept this for what it is: a gray zone, a spectrum. As such, both the legal ramifications and moral judgments for women in this gray zone should not be sharply black/white. That is why I am pro-choice, and why I think the rest of America should be, too."
Struck me as succinct and accurate. I've espoused the big-picture, long-term, statistical view here, that this is not a good way to expend resources overall. Fighting that view angrily is the small-scale, parental view, which of course is in favor of doing anything possible to save the child. And there's the political abortion debate on both sides as well.
But I think Liz nailed it, this is a very case-by-case issue, not to be absolutely determined by law nor the likes of us commenters.
And I apologize for offending folks with my earlier statements, but there's a major emotional motivator behind my tone. I saw the photo here, of Michah Pickering on his birthday at 22 weeks. The empathic blast I got from it, of the uncomprehending, wordless agony he must have been suffering, was like a knife to the eye. So that's where I was coming from on this.
At any rate it's been good debating this with y'all and I hope nobody here has to go through this choice.
From Liz, Seattle, WA
"We should accept this for what it is: a gray zone, a spectrum. As such, both the legal ramifications and moral judgments for women in this gray zone should not be sharply black/white. That is why I am pro-choice, and why I think the rest of America should be, too."
Struck me as succinct and accurate. I've espoused the big-picture, long-term, statistical view here, that this is not a good way to expend resources overall. Fighting that view angrily is the small-scale, parental view, which of course is in favor of doing anything possible to save the child. And there's the political abortion debate on both sides as well.
But I think Liz nailed it, this is a very case-by-case issue, not to be absolutely determined by law nor the likes of us commenters.
And I apologize for offending folks with my earlier statements, but there's a major emotional motivator behind my tone. I saw the photo here, of Michah Pickering on his birthday at 22 weeks. The empathic blast I got from it, of the uncomprehending, wordless agony he must have been suffering, was like a knife to the eye. So that's where I was coming from on this.
At any rate it's been good debating this with y'all and I hope nobody here has to go through this choice.
41
It is questionable whether a 22 week fetus is capable of feeling pain as its neurological system is is so undeveloped.
These are decisions that should be made by parents and their doctors. It is not a black or white issue and many factors should be considered. None of us should sit in judgement of what others do under these circumstances. Not everyone has the ability and support to cope with poor outcomes. Not all of us have medical insurance to cover million dollar+ care, or the personal resources to do so. States do not have the money to provide expensive treatment, or services required during the lifetime of the person. Quality of life is a factor for many. Not every baby born prematurely will survive, and maybe not all are meant to do so. Two of my three children were premature. Those were stressful times I would not wish upon anyone.
17
The history of medical advances is basically that of experimenting until you get it right. That certainly serves science and "the greater good," but at often unspeakable suffering for the individual.
As others have noted, many of these extremely pre-term deliveries are the result of fertility treatments, and these births are likely to increase.
There is really no answer to this dilemma. In a perfect world we'd be able to pay for every treatment every person needed. That world isn't here yet. If the costs for one micro-preemie (horrible term!) can reach several million dollars, who is actually paying for it? Can all of us afford to have our health insurance premiums rise forever to cover these costs? Parents interviewed for this story, and some commenters affected by these circumstances, say they would pay anything. But they are not actually being billed several million dollars. No hospital would try to collect that directly from them. So society is an important stakeholder in this conversation. There is only a finite number of healthcare dollars available. That is cruel but true, and it will never change.
Many of these surviving babies will need lifelong special services. What will happen to the more severely handicapped ones as their parents age and die? Is it right to burden siblings with their care? These are painful questions that must not only be asked, but answered.
As others have noted, many of these extremely pre-term deliveries are the result of fertility treatments, and these births are likely to increase.
There is really no answer to this dilemma. In a perfect world we'd be able to pay for every treatment every person needed. That world isn't here yet. If the costs for one micro-preemie (horrible term!) can reach several million dollars, who is actually paying for it? Can all of us afford to have our health insurance premiums rise forever to cover these costs? Parents interviewed for this story, and some commenters affected by these circumstances, say they would pay anything. But they are not actually being billed several million dollars. No hospital would try to collect that directly from them. So society is an important stakeholder in this conversation. There is only a finite number of healthcare dollars available. That is cruel but true, and it will never change.
Many of these surviving babies will need lifelong special services. What will happen to the more severely handicapped ones as their parents age and die? Is it right to burden siblings with their care? These are painful questions that must not only be asked, but answered.
259
The same argument can be made about treatment for adult patients who received
very aggressive,extremely expensive medical care in the last months,or even weeks, of their lives,with no chance of survival. Yet Medicare pays for such care all the time.
What is your stance in terms of yourself? Are you planning on accepting treatment after a certain point in time,in favor of the “greater good.”?
very aggressive,extremely expensive medical care in the last months,or even weeks, of their lives,with no chance of survival. Yet Medicare pays for such care all the time.
What is your stance in terms of yourself? Are you planning on accepting treatment after a certain point in time,in favor of the “greater good.”?
12
DJS: I don't believe in "the greater good." I don't believe it is worth it to torture a tiny infant so that we might perhaps someday save a dozen tiny infants. I don't believe in extending life if every extra day gained is agony and loss of dignity. My family understands that I, and they on my behalf, will always choose comfort and pain relief and the preservation of my dignity over the chance of survival.
I was shocked and horrified, a few years ago, when my mother mentioned that her friend's very elderly, bedridden mother had stopped eating and drinking, and was taken to the hospital for "treatment." I couldn't understand why that poor woman was not allowed to die naturally and comfortably at home. The body shuts down in preparation for death and does not require nourishment.
It is a specious argument to mention the funds spent on Medicare patients to keep them alive beyond a reasonable point. That is as cruel as keeping babies unequipped to survive outside the womb hooked to a dozen different machines.
There are always miracles and exceptions in cases of devastating medical situations. The one baby who successfully reaches school age is plastered all over the news, and the hundreds who live in constant pain and profound disability are invisible to all but their families.
I was shocked and horrified, a few years ago, when my mother mentioned that her friend's very elderly, bedridden mother had stopped eating and drinking, and was taken to the hospital for "treatment." I couldn't understand why that poor woman was not allowed to die naturally and comfortably at home. The body shuts down in preparation for death and does not require nourishment.
It is a specious argument to mention the funds spent on Medicare patients to keep them alive beyond a reasonable point. That is as cruel as keeping babies unequipped to survive outside the womb hooked to a dozen different machines.
There are always miracles and exceptions in cases of devastating medical situations. The one baby who successfully reaches school age is plastered all over the news, and the hundreds who live in constant pain and profound disability are invisible to all but their families.
11
Re your question "Are you planning on accepting treatment after a certain point in time":
In comments appended to various Health columns in this newspaper, you'll find an overwhelming number of us planning on rejecting end-of-life treatments. Giving elderly Alzheimer's patients antibiotics for a pneumonia that would end their suffering seems to me a criminal waste of resources. Keeping old, near-comotose people on chemo drips until they die because their middle-aged children are waiting for a miracle is also disgusting.
At least those cases are relatively finite. To spend millions on a preemie who will every year need millions more in care for the next thirty years -- assuming a low life-expectancy -- is also a waste of resources.
We all lose loved ones. And one day they'll lose us too. So it goes.
Which is not to say I'd begrudge expensive experimental cancer (or other) drugs for fifteen-year-olds and fifty-year-olds. Having a cousin survive -- and well -- advanced metastatic breast cancer for as long as she did, over a dozen years, was a great blessing for our family.
In comments appended to various Health columns in this newspaper, you'll find an overwhelming number of us planning on rejecting end-of-life treatments. Giving elderly Alzheimer's patients antibiotics for a pneumonia that would end their suffering seems to me a criminal waste of resources. Keeping old, near-comotose people on chemo drips until they die because their middle-aged children are waiting for a miracle is also disgusting.
At least those cases are relatively finite. To spend millions on a preemie who will every year need millions more in care for the next thirty years -- assuming a low life-expectancy -- is also a waste of resources.
We all lose loved ones. And one day they'll lose us too. So it goes.
Which is not to say I'd begrudge expensive experimental cancer (or other) drugs for fifteen-year-olds and fifty-year-olds. Having a cousin survive -- and well -- advanced metastatic breast cancer for as long as she did, over a dozen years, was a great blessing for our family.
8
Thank you to the NYT and its readers for very interesting and widely varied comments regarding resuscitation of 22 week infants even when modern outcome stats show at best 90% severe disability or death rates. As someone that cares for these infants on a daily basis, it is important to understand there are wide ranges of opinions on this very controversial area of neonatology.
13
There was a time when 30-week babies didn't make it. They have a better chance now specifically because of techniques developed by medical people who didn't want to just give up on them. My nephew was one such; he just finished his sophomore year in college on an ROTC scholarship and was sworn into the Air Force.
1
Wow, so shocking there are so many posts complaining about the cost of preserving the life of a 22 wk premature babies. Does it mean old peoples care should be distributed according to cost too? The pro-abortion group is resorting to rationale that is very disturbing.
16
Greedy insurance companies have plenty of complaints about high costs of preserving human life too. Their rationales are even more disturbing.
2
To deny that cost of care for babies born very early is extensive is to not be practical with an issue that has to be faced not just for pre-premies, but for elderly also. Hospitals, in many cases, already write off huge amounts of money because of patients who can never repay what the bill came to. Medical bills have made thousands of people go into bankruptcy and or near poverty.
There have been several fine comments written here about ways in which the hospitals might best decide babies who gets treatment and who does not. Money spent on those that would appear to have a good chance of surviving and not being mentally or physically damaged seems more reasonable than treating all and having negative outcomes in the end. The expense of a mentally or physically handicapped child over a lifetime is uncountable as time creates its own economic changes socially.
As to limiting aid to the elderly, being 82 myself I believe that as I get older and my health might fail, taking needed resources that will have only a limited result of me living just a few months more would almost, IMOHO, be extremely selfish. I speak only for my own self, as others may feel that life as long as there is breath is preferred.
There have been several fine comments written here about ways in which the hospitals might best decide babies who gets treatment and who does not. Money spent on those that would appear to have a good chance of surviving and not being mentally or physically damaged seems more reasonable than treating all and having negative outcomes in the end. The expense of a mentally or physically handicapped child over a lifetime is uncountable as time creates its own economic changes socially.
As to limiting aid to the elderly, being 82 myself I believe that as I get older and my health might fail, taking needed resources that will have only a limited result of me living just a few months more would almost, IMOHO, be extremely selfish. I speak only for my own self, as others may feel that life as long as there is breath is preferred.
5
It is nonsense to believe that one can ignore the cost of medical care. Some states-- Hawaii is one--have exceptional public financing of medical care for people of all ages, but citizen pay taxes for it. Most states deny or restrict medical care based on cost at all ages. And if you follow the End of Life discussions in the NYT you will read most older adults, especially those too poor to afford a Medigap policy or the co-pay for drugs have had restricted medical treatment options for years. Now many more adults choose palliative care when faced with a terminal medical event based on a desire for a peaceful death. Telling the truth about a for-profit medical care system which rations care through cost has nothing to do with abortion policy--FYI
5
I 'm not all that concerned with the ramifications for abortion because I don't have a lot of sympathy for women who delay the abortion decision until so close to the point of viability. My greater concern is why all the time, effort, and money is being poured into treatment of premies who have little chance of survival. It seems like the flip side of expensive treatment of the elderly with little hope of prolonging their lives.
22
Women who have an abortion to close to the point of viability have often intended to have the baby but as a result of the amniocentesis, learned that their baby had an abnormality that would prevent the child from being born, living long, or having a normal, healthy life.
43
I am in the category of "getting old and decrepit". I am a nurse. I also live alone. I DO NOT want to spend my remaining years in a bed not aware of what is going on around me. I am not afraid to die; I am afraid to live too long. I don't want money spent on me that could be used in a more appropriate way. Death is natural; it will happen to all of us some day. (And besides, there is NO other way for Christians to get to heaven).
5
outis -- amniocentesis to test for birth defects is normally done around week 16. And your claim that most late term abortions are conducted because of concern about birth defects is disputed. Many women who wait are simply wavering on whether to get an abortion.
As someone who has had a premature baby...I am not sure I would want that for my child. I just don't know. We were 'lucky' and my son was born at exactly 32 weeks. There were babies much smaller and sicker than my son. They were on ventilators, had surgeries. Premature babies are often born to very young mothers or women with little to no prenatal care. My son was often the only baby with a parent at his crib for days on end. I don't know how we could have done that if we had had an older child at home.
When I did talk to another mother or grandmother they were often overwhelmed at the idea of how they were going to provide care for their sick baby at home. Cerebral Palsy, blindness, ADD, autism, retardation, we were constantly warned to prepare for all of it. My husband and I were lucky enough to have health insurance but we still had to pay thousands. It took years to pay off. I don't know how we would have coped with more major medical expenses after leaving the NICU.
Some of the kids in the NICU with my son went on to live very limited lives and their families have faced huge financial and emotional challenges. If we commit to saving sicker and smaller preemies, I hope we, as a society are ready to support them just as much when the leave the NICU because they are going to need it. It is going to be a lifetime of medical care.
When I did talk to another mother or grandmother they were often overwhelmed at the idea of how they were going to provide care for their sick baby at home. Cerebral Palsy, blindness, ADD, autism, retardation, we were constantly warned to prepare for all of it. My husband and I were lucky enough to have health insurance but we still had to pay thousands. It took years to pay off. I don't know how we would have coped with more major medical expenses after leaving the NICU.
Some of the kids in the NICU with my son went on to live very limited lives and their families have faced huge financial and emotional challenges. If we commit to saving sicker and smaller preemies, I hope we, as a society are ready to support them just as much when the leave the NICU because they are going to need it. It is going to be a lifetime of medical care.
115
I'm a mother of a growth restricted 27 week preemie (now in preschool). To quote one of our NICU neonatologists: "Our 26 weekers do very well neurologically." Be careful about citing anectotal evidence as freely as you are doing. You are giving people the wrong idea.
8
'Infants born at 32 weeks are highly susceptible to intraventricular hemorrhage (IVH)' [1]. 26-weekers, therefore, six weeks younger still, do not do well neurologically. That is not anecdote but an epidemiological fact.
1) http://learnpediatrics.com/body-systems/neonate/consequences-of-prematur...
1) http://learnpediatrics.com/body-systems/neonate/consequences-of-prematur...
3
The artcle supports the anecdote with facts.
3
Let me restate what I meant in my earlier post. I understand the bigger picture - really, I do. However; being the aunt of a 22 weeker leaves me slightly biased and not objective. I can tell you, when my sister went into labor at the University of Iowa - she was given a choice. She was told that her son had less than a 10% chance of survival. She was told of the immediate complications and what the complications in the future could look like. She was not told of the costs associated with lifesaving procedures, heart surgery, and a 4 month nicu stay. What I know is that the doctors gave her the choice to use their resources, their talents and their technology to try and save the life of her son. I can assure you, had she been told that her medical bills would estimate to approximately $1,000,000 - she would have proceeded to do it. It surprises me that the majority of this discussion is based on costs. Premature births, especially 22 -23 weekers, are a fraction of the costs seen in the medical world. Lifesaving measures are taken every single day for all different types of illnesses and classes of people. To say that anyone would not attempt to save their own, their childrens, spouses, etc... lives because they didn't have the money? I whole heartily disagree.
17
18,000 x $1million (conservative estimate of lifetime care in excess of that of a normal child) = $18 billion per year. Just imagine how many more and how much lives can be saved and improved with proper prenatal care to prevent such events.
27
Yes, K, yesterday many here wanted free medical air evacuation.
1
My sister had proper prenatal care. There is no medical explanation as to why she had Micah early. She is now 33 weeks pregnant, 3 years later and has no issues.
1
Correction, I was supposed to be born in early April not August.
I am rather pragmatic and with each of my pregnancies I made my husband promise that if the baby came too early, we would grab the baby and run home. The ADA guidelines might have lead to our arrest, but that was my plan.
I think this is a conversation, like end of life/hospice issues, that needs to be done before the crisis. You can always change your mind, but by having the conversation before the crisis, you have something to start from.
I think this is a conversation, like end of life/hospice issues, that needs to be done before the crisis. You can always change your mind, but by having the conversation before the crisis, you have something to start from.
33
Another way to retain complete control over your future and the future of your family is to have the baby at home with an experienced midwife.
I shudder for parents faced with such decisions while in the grip of an emergency. Offers of hope should be tempered with caution. As I read it, Fewer than one in 10 of these tiny infants survived without significant disabilities.
26
The article is fuzzy about what it means by significant problems. I might say that my former preemie has severe delays in fine motor, gross motor, articulation, and is below the charts on weight...and that would sound really bad. But those problems don't even begin to paint the real picture. She is happy and healthy, sweet and delightful. She is a beautiful ray of sunshine that brings joy into our life and others. She's tiny and delayed...but this planet is better off for having her here.
9
Everyone has a disability in life. Some just have more than others.
Born at 27 weeks, big difference.
So why is it many readers support "just let these children perish" ?
There seems to be an equal concerns between economics of saving a child's life and the possible consequences of changes to abortion laws.... But perhaps what they are really thinking is lets invest in only medical advances that test to determine if an unborn child is worthy to be born or to abort....
There seems to be an equal concerns between economics of saving a child's life and the possible consequences of changes to abortion laws.... But perhaps what they are really thinking is lets invest in only medical advances that test to determine if an unborn child is worthy to be born or to abort....
9
no it is about the unspeakable suffering the infant and parents go through to then most likely have a child with severe disabilities and thus a lifetime of more pain and little joy
2
How much time have you spent with kids in really poverty stricken neighborhoods? In drug infested neighborhoods? On reservations? At the same time, why have kids at all? This is not a question of worthy to be born. This is a question of what each family, as individuals, values in their child's life? How much risk do you take is very personal. If the kids is somewhat impaired, that's one thing. If the kid never has awareness that he or she is a human on a beautiful planet, another.
Your judgements strike me as a bit unforgiving. Tough enough situation for so many...
Your judgements strike me as a bit unforgiving. Tough enough situation for so many...
This is MRS. While I, too, realize that this article is about the cost associated with trying to support these tiny neonates while they are unable to go home and the cost of supporting their needs after discharge, it's also about quality of life issues. Should the care they receive be solely palliative or aggressive? This child is so young (and, of course of the age of minority) that he or she cannot execute an advanced directive regarding medical care in crisis. DNR and DNN directives should be the province of the parents, but they are not. There are many very fine neonatologists out there, but how much is too much and who should make that final decision? Parents who know they cannot raise a severely handicapped child should be the ones to make the final decision; social workers should stay out of that decision; and doctors should respect parents who have chosen a very tough decision not to treat.
2
Life is what we make it , while at the same time it is not pretending to anything different what it might be...
Surely a consideration not even discussed in this article is what is causing these extremely premature births in the first place.
26
Alas, in 50 percent of cases, the premature birth is "not indicated," or, nothing can be identified.
2
Exactly. 18,000 x $1million (conservative estimate of lifetime care in excess of that of a normal child) = $18 billion per year. Just imagine how many more and how much lives can be saved and improved with proper prenatal care to prevent such events.
This is the best example of expensive technology begets more expenses in medicine.
This is the best example of expensive technology begets more expenses in medicine.
9
Prematurity is often the result of poor prenatal care and that may be a result of the absence of a continuing relationship with an OB/GYN or midwife. Young women are often more susceptible to that then older, more settled mothers.
This may be a bit off subject, but perhaps readers will understand the parallels between this article and the life of Winston Churchill, in particular his military and political careers. Prior to becoming Prime Minister during one of the most horrific times in past hundred years, he had many failures during World War I; however, his insight, perseverance in short paid off during World War II.
As a result, if Churchill did not make those hard decisions, the outcome WWII may have been much different or at least prolonged. Therefore, as more parents who may face such hard decisions as noted by many readers, side with medical advances, eventually more advances will emerge thus increasing the odds of better survival with less complications later in life for their children...
As a result, if Churchill did not make those hard decisions, the outcome WWII may have been much different or at least prolonged. Therefore, as more parents who may face such hard decisions as noted by many readers, side with medical advances, eventually more advances will emerge thus increasing the odds of better survival with less complications later in life for their children...
4
We had twin boys born at 28 weeks. They're 16 now, both severely handicapped with autism, profound intellectual disabilities, and cerebral palsy. One's disabilities are so severe that we made the gut-wrenching decision to place him outside of our home in an intermediate care facility for the intellectually disabled (a group home with 5 other disabled children). Luckily we have the means to play an important advocacy role in his life. I remember vividly how one NICU doctor told us not to worry and that our boys will be fine-- they just won't be very good at math. (I didn't believe him at the time, but, unlike the article suggests, had absolutely no choice with respect to the care they were given.) Viability or survivability means nothing to me--these doctors do NO follow-ups whatsoever--NICU units are cash cows for hospitals. I worry about who will be there for my boys when I'm gone. These issues are never covered in great detail in such articles, even though the numbers of preemies with outcomes like my sons are numerous.
274
Sad but true. Neonatologists never see the babies once they are out of the unit. Future hospital admissions will always go to the PICU--totally different docs.
But also true that no hospital gives parents any say at 28 weeks, only at 22-24 weeks. And what you see in the article is how the attitude/wording/recommendation will change depending on if you're in a red state or a blue state. Blue states don't refuse to save their lives, but they give more honest information. Red states assume all patients are anti-abortion and pro-life, and are afraid to even mention the option of comfort care.
But also true that no hospital gives parents any say at 28 weeks, only at 22-24 weeks. And what you see in the article is how the attitude/wording/recommendation will change depending on if you're in a red state or a blue state. Blue states don't refuse to save their lives, but they give more honest information. Red states assume all patients are anti-abortion and pro-life, and are afraid to even mention the option of comfort care.
19
You raise a major issue: our society must plan better for caring for severely disabled people when no family members are available. E.g., here in GR a non-profit group home couldn't survive as a non-profit and became a for-profit investment. So where do the others go.
2
This has been changing over time. Most big NICUs now run Special Infant Care Clinics, or SICCs. These are staffed by neonatologists and those pediatricians trained in the new SICC fellowships. They monitor patients closely over at least the first two years of life and have multidisciplinary care, typically with at least physical, occupational, and speech therapists and nutritionists available. Many of my patients are followed by these clinics.
Awesome! I will not burden myself to carry my children to 38 weeks when I don't have to go through that inconvenience!! What a medical break through!
9
At last, a cure for stretch marks!
I was born prematurely at 24 weeks. I was born early in January and I was supposed to be born in early August. I weighed only 2 pounds. I spent five months in the hospital fighting to survive, there was even one night when I lost my vital signs and I died. I had to have surgery on my heart, and the scar from that surgery is a constant reminder of the great miracle that I am here.
My sister was born about three years before me. She was born more prematurely than I was. The doctors didn't do anything to save her life, they didn't keep my parents in the loop, and she died. We will never know what would have happened if they took aggressive treatment what the outcome might have been--perhaps she still would have died or perhaps not.
A social worker told my parents (both college educated) after observing me for a few hours...that I would never graduate high school. I hold a doctoral degree in history and I am in the process of writing a book. So so much for her brilliant prognostications.
I read this article, and I was shocked at what was being said by doctors and others. We should do everything in our power to save even extreme cases of "micropremies." That shouldn't makes us have a second thought. And certainly consideration about abortion (which is murder plain and simple and should be banned) should not enter into the decision making process. My sister's example runs through the pages of this article. Don't let these babies die by doing nothing.
My sister was born about three years before me. She was born more prematurely than I was. The doctors didn't do anything to save her life, they didn't keep my parents in the loop, and she died. We will never know what would have happened if they took aggressive treatment what the outcome might have been--perhaps she still would have died or perhaps not.
A social worker told my parents (both college educated) after observing me for a few hours...that I would never graduate high school. I hold a doctoral degree in history and I am in the process of writing a book. So so much for her brilliant prognostications.
I read this article, and I was shocked at what was being said by doctors and others. We should do everything in our power to save even extreme cases of "micropremies." That shouldn't makes us have a second thought. And certainly consideration about abortion (which is murder plain and simple and should be banned) should not enter into the decision making process. My sister's example runs through the pages of this article. Don't let these babies die by doing nothing.
14
But who pays? And who decides?
Health care costs are a bottomless pit. How many of us are willing to let go of a loved one, or to die ourselves, when there is yet one more treatment to try?
Until we face the ethical dilemma of how to allocate the not-unlimited resources (doctors, nurses, buildings, equipment, et al) available for medical care, we will continue to argue without resolving the problem. And if we do confront this ethical-economic dilemma, we won't like our choices.
Health care costs are a bottomless pit. How many of us are willing to let go of a loved one, or to die ourselves, when there is yet one more treatment to try?
Until we face the ethical dilemma of how to allocate the not-unlimited resources (doctors, nurses, buildings, equipment, et al) available for medical care, we will continue to argue without resolving the problem. And if we do confront this ethical-economic dilemma, we won't like our choices.
2
What about the babies who live,who are blind or otherwise severely handicapped?
A commenter posted that she had preemie twin who are now 16.They are both severely autistic and mentally impaired.One had to be institutionalized. You are fortunate that you had such a wonderful outcome. Have you given any thought to the lifetime of suffering that the majority of those children who are born at 22 weeks endure?Is it truly a compassionate choice to “do everything in our power
to save even extreme case of “micro preemies” ?Remember, you are the exception.
A commenter posted that she had preemie twin who are now 16.They are both severely autistic and mentally impaired.One had to be institutionalized. You are fortunate that you had such a wonderful outcome. Have you given any thought to the lifetime of suffering that the majority of those children who are born at 22 weeks endure?Is it truly a compassionate choice to “do everything in our power
to save even extreme case of “micro preemies” ?Remember, you are the exception.
4
I have less respect for social workers than most here have for functioning police officers.
2
Something else that bears pointing out -- the Japanese routinely provide life-saving care at 22 weeks, and they get a 30-40 percent success rate.
Another thing this story could use -- it is the American Academy of Pediatrics and its National Resuscitation Program that sets the standard minimum gestational age of 23 weeks and 0 days for resuscitation in the United States. I'd be interested in what opinions the reporter could get from the AAP. Our son was born at 22 weeks and 6 days of gestation, and it took some convincing to get the doctor to resuscitate. I strongly favor the limit being lowered.
Another thing this story could use -- it is the American Academy of Pediatrics and its National Resuscitation Program that sets the standard minimum gestational age of 23 weeks and 0 days for resuscitation in the United States. I'd be interested in what opinions the reporter could get from the AAP. Our son was born at 22 weeks and 6 days of gestation, and it took some convincing to get the doctor to resuscitate. I strongly favor the limit being lowered.
5
Define, "success rate?" How many terrible disabilities? At what cost?
3
We should accept this for what it is: a gray zone, a spectrum. As such, both the legal ramifications and moral judgments for women in this gray zone should not be sharply black/white. That is why I am pro-choice, and why I think the rest of America should be, too.
218
The idea that most everything falls into a gray zone is so exactly suited to America's fondness, in spirit if not in practice, for individualism that it's virtually impossible to counter. It's the piety at the end of every story.
Yet presenting the case as black and white might be a kindness to parents, sparing them a traumatic decision they are ill-equipped to make, so that guilt does not overshadow the time they have with their baby.
Yet presenting the case as black and white might be a kindness to parents, sparing them a traumatic decision they are ill-equipped to make, so that guilt does not overshadow the time they have with their baby.
I cannot agree. The coarseness of our society is directly related to the devaluing of human life inside and outside of the uterus. Many Americans are pro-life (pro-birth control), and anti-death penalty. How do we teach our children compassion to people when we so frequently devalue the so much that we kill them?
I am strongly pro-choice too! But, the insistence of many to favor abortion without restriction (particularly late term abortions after the 24th week) is very disturbing. While the religious right wing crowd is out of step with the majority of Americans; the far left wing crowd who favor late term abortions are equally out of step and we don't hear much about them.
1
Even the 22 weekers who survive and do not have severe disabilities, CP, deaf, blind, will probably have language and learning disabilities, poor coordination and possibly seizures. They will probably be hypo-competitive in a future tough economic environment.
14
In my early life I had seizures, speech delays, fine motor delays, and poor coordination (not related to prematurity, but likely due to some birth trauma). I ended up becoming a neurologist. I met a medical student the other day who survived a terrible seizure disorder as a child as well. I guess in your book we were just not worthy to survive, as are many of my patients.
1
"although the vast majority died or suffered serious health issues...." For me, that speaks volumes. This article focuses on the exceptions to the rule and in the process, hides the misery behind what happens to the "vast majority".
56
To Survive is not the same To Thrive.
57
An infant born prior to 24 weeks is at extraordinary risk for massive medical issues, including neurological damages, and is going to cost communities and hospitals unspeakable amounts of money.
Few nations would be able to cope with routine 22 week premature infants, and have any resources left for the other newborns.
Few nations would be able to cope with routine 22 week premature infants, and have any resources left for the other newborns.
74
Studies of costs incurred by extremely low birthweight infants show that they only account for about 10 percent of NICU expenses, for two reasons -- one, that they are so rare, and two, if they die, they generally do so in the first few days. As the parent of a 22 week 6 day preemie who did survive, I am strongly in favor of allowing care at 22 weeks.
5
Are you just saying that because you are pro-choice?
1
You have to add "families" to "communities and hospitals". The costs are great for everyone.
8
There are several comments voicing disapproval of aggressive treatment for these preemies and receiving lots of recommends. Usually centered on cost and poor rate of survival; then followed by the usual liberal shibboleth that the money would be better spent on "all those poor kids out there" as if billions aren't already being spent.
All red-herrings! The real reason, the one driving these opponents to reflexively voice exaggerated reason for disapproval is the threat to the allowed 24 week period for a legal abortion. However unlikely to alter this point any potential alteration in viability is viewed as undermining a "women's right to an abortion" and warrants criticism - even morally debased cost determinant criticism as many have engaged.
Fundamentally, the prime reason for allowing abortion up to the point of infant viability is a corruption of moral value - a consideration understood but ignored by the Supreme Court decision. With 24 weeks the US is an outlier in the civilized world where others imply a moral attachment to the fetus that is made at a much earlier date - one which has nothing to do with fetus viability and everything to do with the fetus' manifestation of humanness.
So in France or Germany, for example, abortions are restricted after 10 weeks while the US gives itself ever more over to the individual's supreme selfishness.
All red-herrings! The real reason, the one driving these opponents to reflexively voice exaggerated reason for disapproval is the threat to the allowed 24 week period for a legal abortion. However unlikely to alter this point any potential alteration in viability is viewed as undermining a "women's right to an abortion" and warrants criticism - even morally debased cost determinant criticism as many have engaged.
Fundamentally, the prime reason for allowing abortion up to the point of infant viability is a corruption of moral value - a consideration understood but ignored by the Supreme Court decision. With 24 weeks the US is an outlier in the civilized world where others imply a moral attachment to the fetus that is made at a much earlier date - one which has nothing to do with fetus viability and everything to do with the fetus' manifestation of humanness.
So in France or Germany, for example, abortions are restricted after 10 weeks while the US gives itself ever more over to the individual's supreme selfishness.
17
Please don't put words in other people's mouths. We have a failed policy in this country of "treating" everyone, regardless of outcome, and it has made our health care system the most costly but poor in effectiveness among developed countries. There comes a time when we have to make decisions, and with a decent survival rate at around 16% and massive costs regardless, perhaps this isn't where our medical money should go, the same that a 90-year-old woman doesn't need a mammogram. Sure, my grandmother had that mammogram at almost 90 and then had both breasts removed and lived to be over a hundred, but she was already suffering from dementia when she had the breasts removed. How is that good medicine?
49
So the fetus magically gets "humanness" at ten weeks instead of twenty four weeks? Huh.
4
You can get an abortion after 10 weeks in Europe too, you just need to know who to ask.
6
I thank God I did not face this situation, and none of us--regardless of what we believe in theory--knows how we would react if faced with our own child born alive so prematurely. I do not think any parent can affirmatively utter the words "do not treat my child."
But sometimes true love and mercy lie in avoiding medical intervention. A child very likely to die, and subjected to intense treatments, will suffer terribly; experience fear and pain. It might be much better--to take what few hours an untreated child may have, holding and loving it; letting it feel the touch of its parents and the sound of their voices, rather than needle sticks in almost-invisible veins, the awful sounds of ventilators and monitors and alarms.
Only a few decades ago, mainstream medical opinion was that newborns felt no pain, and major surgeries were performed on newborns without anesthesia (only muscle-paralyzing drugs were given to immobilize the babies). Yet any mother could have told you that the doctors were wrong and that infants are aware and responsive to pain--to every kind of touch--from the moment of birth. I know that not too long in the future, we will document that fetuses feel pain too.
How much suffering should a child be subjected to, in order to possibly obtain a miracle? Sometimes love means disregarding your own anguish and doing what is truly right for your child.
But sometimes true love and mercy lie in avoiding medical intervention. A child very likely to die, and subjected to intense treatments, will suffer terribly; experience fear and pain. It might be much better--to take what few hours an untreated child may have, holding and loving it; letting it feel the touch of its parents and the sound of their voices, rather than needle sticks in almost-invisible veins, the awful sounds of ventilators and monitors and alarms.
Only a few decades ago, mainstream medical opinion was that newborns felt no pain, and major surgeries were performed on newborns without anesthesia (only muscle-paralyzing drugs were given to immobilize the babies). Yet any mother could have told you that the doctors were wrong and that infants are aware and responsive to pain--to every kind of touch--from the moment of birth. I know that not too long in the future, we will document that fetuses feel pain too.
How much suffering should a child be subjected to, in order to possibly obtain a miracle? Sometimes love means disregarding your own anguish and doing what is truly right for your child.
58
So does this mean we shouldn't subject children to chemotherapy and cancer surgery? We have no way of determining the outcome with that either and there are tremendous side effects, often leading to lifelong disability, with those treatments as well.
When parents do everything and hope for a miracle for there 3, 5 or 7 year old child no one seems to say they are selfish and should accept the inevitable. Why should they give up on their premature child?
When parents do everything and hope for a miracle for there 3, 5 or 7 year old child no one seems to say they are selfish and should accept the inevitable. Why should they give up on their premature child?
5
And who will pay for the sophisticated technology in intensive care? Will that be covered in employers' health plans? what will be the long term effects on the children who survive? Does it not mean months of torture for these tiny newborns? Is the the technology widely available? what about the effects of having a newborn in a hospital for months on the rest of the family? This is pretty ethically complicated.
34
Million dollar babies--but we must choose how we want to allocate our healthcare $$. Unless we achieve huge efficiencies (national health insurance with everyone chipping in - like Medicare for All)- there is no current way to finance all the joint replacement, MRIs, coronary bypasses, palliative home care, basic cancer screening, prevention, chronic diseas management, research, medical infrastructure, et al....and promise every 22 week premie a 'full court press' with lifetime support.
6
You are obviously a young person who is ignorant of the facts. Or you would know that Medicare isn't free. You have to pay for it. First upfront, with deductions from your paycheck. And then you pay after you retire with monthly premiums that can run $300 a month or $3,600 a year per person. My wife and I spend $7,200 a year on Medicare, plus another $3,500 out of pocket for all of our prescriptions. Medicare costs us close to $10,000 per couple. I don't think most people can come anywhere close to affording that. And yet you want Medicare for all, with nobody paying anything. Great concept. Naive execution.
8
Newsjunkie, unclear on the concept. We would all pay premiums under Medicare for all; just not inflated for 20 pct profit margins and overhead.
It is striking that nowher in this story is here any hint, much less discussion , of the staggering cost of five months of NICU care, and how it is being paid for. Nor was there anything about the fact that many of these babies are twins born to parents going through in vitro fertilization. Both of these issues are as deserving of airing in this context as the simple odds of survival at a given age.
116
Right. The shameful assisted fertility industrial complex bears a large share of blame here and should bear more of the costs. If a doctor's assisted repro advice results in volatile, expensive pregnancies and one or more expensive, sick neonates, the doc or his insurance company should be picking up the tab. Maybe sharing the financial distress would shape their advice.
Profiting from producing these costly and inhumane outcomes, on a planet already struggling with the food, water and other denands of 7 billion people, is obscene.
Profiting from producing these costly and inhumane outcomes, on a planet already struggling with the food, water and other denands of 7 billion people, is obscene.
2
Something fishy here, me thinks. It is conceivable to me that the minimum viability age could shrink to the actual union of an egg and a sperm. Does that rule out the morning after pill?
8
It should.
1
Women are just incubators?
3
My son was born at 26 weeks and he was pretty large for gestation. He did not receive the steroids prior to birth as it was not expected. He is also a white male and in the world of the NICU that was very much against him. He spent 106 days in the NICU. He was on a ventilator and oscillator for 6 weeks. He is deaf due to a drug interaction he was mistakenly given in the NICU. His stay there was almost $2 million dollars.
They had asked me repeatedly if I was ready to withdraw life support. I was not.
Today he is 2 1/2. He has cochlear implants and is happy and relatively healthy. I can not imagine if I had decided to stop his treatment.
I think the decision to treat or not must lie with the family. While most parents know the odds are against them surviving, especially without long term effects, they must make that decision. It is heart wrenching and difficult, but it must be the parents' choice.
They had asked me repeatedly if I was ready to withdraw life support. I was not.
Today he is 2 1/2. He has cochlear implants and is happy and relatively healthy. I can not imagine if I had decided to stop his treatment.
I think the decision to treat or not must lie with the family. While most parents know the odds are against them surviving, especially without long term effects, they must make that decision. It is heart wrenching and difficult, but it must be the parents' choice.
55
It is so easy for others to make the hard decisions for you. Let's see what happens when they are face-to-face with potential disasters in their lives.
1
Totally agree, but with one caveat that is difficult to resolve. The parents should be given the unvarnished truth. The neonatologist's self interest is tied to continuing life support and his/her opinion is biased.
6
You say that you believe that the decision whether to treat should lie with the family. “It is heart wrenching and difficult, but it must be the parents’ choice.”
“His stay there was almost 2 million dollars.”
Presumably,you did not pay that 2 million dollars out of pocket. The decision is more than heart wrenching and difficult. It is also a choice that take 2 million dollars of health care dollars away from others.I do not know what the answer is. I am glad that your son is alive,happy,and relatively healthy.
“His stay there was almost 2 million dollars.”
Presumably,you did not pay that 2 million dollars out of pocket. The decision is more than heart wrenching and difficult. It is also a choice that take 2 million dollars of health care dollars away from others.I do not know what the answer is. I am glad that your son is alive,happy,and relatively healthy.
16
The real question here is, "What does the baby want?" Premature babies should have the right to accept or deny treatment since it could leave them debilitated later in life.
3
This is a great insight! The foundation of medical ethics is to ask and try to answer the question "What does the patient want?"
1
So, because a tiny minority of babies born at very early ages can survive without damage we should subject all babies born at that age to prolonged painful treatment resulting in death or serious health issues? Really? And you call yourselves moral?
172
We do not determine a full-term neonatal, pediatric, adult or geriatric patient's worth based off the cost of treatment or their dependence on medical technologies. So why should premature 22-weekers be any different when medical advances have made survival possible--even with crippling disabilities (wouldn't denying treatment due to possible disabilities be illegal according to the ADA once a child is outside the womb)?
If 22-weekers can survive 25% of the time, then the families should be able to choose to accept life-saving treatment. As it is now, hospitals may have policies that prohibit any intervention before 24 weeks gestation, even when survival is an attainable possibility. How devastating for those families to not even be given the chance.
The correlation with reproductive rights is important to consider. If a 22-week old can survive outside the womb, there is a serious conflicts of rights at play at that point.
If 22-weekers can survive 25% of the time, then the families should be able to choose to accept life-saving treatment. As it is now, hospitals may have policies that prohibit any intervention before 24 weeks gestation, even when survival is an attainable possibility. How devastating for those families to not even be given the chance.
The correlation with reproductive rights is important to consider. If a 22-week old can survive outside the womb, there is a serious conflicts of rights at play at that point.
10
Because there is a difference between tossing a damaged acorn on the conpost heap and sawing down an 80-year-old oak.
1
There is no conflict. The parents have the rights. How are you going to get a 22 week gestation preemie to sign off on a form?
This article should mention that parents do not have the choice regarding treatment. The hospital sets their own policy, and most have taken the position that they will treat ALL premature babies born at their hospitals past the date they deem viable. So if these hospitals change the date to 22 weeks, and you show up in emergency labor at that particular hospital, they will MANDATE that you treat your baby -- despite these horrible statistics. And the costs of both prenatal care and the lifetime of medical bills that follow will fall entirely on the parents, even if they begged and pleaded to not treat at 22 weeks. Sad stuff.
172
Hospital policies aren't formed in a vacuum; state laws, i.e., the legislators, play a role on whether treatment is forced, and on whom (adults with a DNR may be affected, too.)
Why does this article feature exclusively micropreemies who survived without serious injury? The text talks about how very rare it is for a micropreemie to survive without major disability, and yet the pictures and interviews feature that rare outcome.
141
The reason is that the media is the media---focused on the miraculous exceptions that tell a heart wrenching anecdote instead of blunt statistics that show reality.
10
The net increase per day of the human population is about 324,000 which translates to 118,260,000 per year. [http://www.census.gov/popclock/]. The growth rate is exponential - the rate of increase is increasing geometrically. Why are limited resources committed to prolonging the life of immature infants. A better idea is to use the limited resources to develop a male contraceptive that can be dispersed in human water supplies. It will be unrelenting growth of the human population that will eventually end human dominance of the biogeosphere.
31
Eh, seriously? We should aim to eliminate all personal reproductive choice by putting birth control in the water supplies?
Seriously until the size of the human population is within the carrying capacity of Earth. Many believe that personal reproductive choice is a right. What will they believe when the resource base is insufficient to meet human needs?
IF only we could improve the services to babies twenty-two months after they were born.
130
You are suggesting that babies not be turned over to their parents and stay in the equivalent of government-funded "intensive care" for their entire childhood? Any idea what that would do to society?
1
At 22-23 weeks what is the incidence of ROP (retinopathy of prematurity)?
4
According to an NICHD study published in 2010, for 22-weekers, there's a 57 percent occurrence of retinopathy of prematurity at stage 3 or worse, for 23-weekers, it's 48 percent occurrence of ROP.
1
I wonder what will happen as the age of viability gets lower and lower - as it surely will. At what point does it become a person and not just fetal material? It is going to be fun to watch all the hand wringing from both the left and the right. Reproductive rights may in the end devolve back to - 'don't get pregnant.' Ha! How ironic. My popcorn will be ready!
8
Why do you assume the age of viability will get "lower and lower-as it surely will"? I was a NICU nurse at two of the top children's hospitals in the country from 1986-1994. Guess what the age of viability was back then? It was 24 weeks, maybe, but rarely, 23 weeks. Not much has changed in two decades.
2
What about preemies who are born at 26 1/2 weeks, have no issues, but need 10 weeks in the NICU before they can come home?
Total cost: $250,000 back in 1989.
Does that child have a moral right to live, regardless of cost?
Total cost: $250,000 back in 1989.
Does that child have a moral right to live, regardless of cost?
1
That dilemna is approaching and will expose the ancient belief that life begins at bitth as a myth. It wont cause any hand wringing among those who hold that life begins at conception.
2
Given the apparent uncertainty, how would you know that the 7 children without moderate or severe impairments were not given underestimates of gestational age?
22
Ms. Belluck, please balance this article with a discussion of the ethical and economic issues. Who exactly benefits from this technological advance? Certainly not people without the best health insurance or great wealth. Also, please report on the far preferable advances in research to prevent premature births in the first place.(http://www.nichd.nih.gov/health/topics/preterm/researchinfo/pages/activi.... Gestation is mother nature's job, not the NICU's.
47
Is getting hit by a car and needing lifesaving measures, "Mother natures job"? Is getting cancer or another disease without a cure, "mother natures job" My point - if someone was hit by a car - doctors and loved ones would do everything they could do in to heal them. If someone was diagnosed by cancer and only had a 10% shot of surviving with a new treatment that didn't guarantee survival and had a whole list of side effects and costs a whole lot of money - pretty sure they would proceed with the treatment.
Brilliant. There are enough problems with babies born at 24 weeks! Just because you can doesn't mean you should. If nature wants a baby to be viable, it is carried to term. Premies often have health problems and birth defects. Do doctors actually warn their patients about this?
I'm starting to feel like we are living on the island of Dr. Moreau!
I'm starting to feel like we are living on the island of Dr. Moreau!
36
This article, which is probably consistent with anecdotal observations and perspectives, makes no ethical inroads, imho.
11
What is a sophisticated NICU? I know NYT needs to dumb it down for the layman, but I think most people can understand levels of care if you told them there are 3 levels of NICU, with level 3 unit being able to care for all premature infants.
Outcomes for very premature infants (25 weeks and up) have improved tremendously, some of the benefits of these new technologies (sophisticated!) also flowing towards borderline viable babies, although it would be foolish to paint a rosy picture. Overall, neonatal care is money (medicaid, mostly) well spent as opposed to the medicare dollars wasted in the last 6 months of one's life.
Outcomes for very premature infants (25 weeks and up) have improved tremendously, some of the benefits of these new technologies (sophisticated!) also flowing towards borderline viable babies, although it would be foolish to paint a rosy picture. Overall, neonatal care is money (medicaid, mostly) well spent as opposed to the medicare dollars wasted in the last 6 months of one's life.
3
The supposed relationship to abortion is ignorant, and meant just to serve politics. None of us "survive". Since I am 50 years old and statistically will be "viable" for only about 25-30 years, is it okay to terminate me now?
12
Just reaching out in sympathy to all the grieving parents who read this article and are now flashing back to the memory of their 22 week-old baby dying before their eyes. It's been nearly twenty-five years since I attended a loved one at such a delivery, and I remain haunted.
Tread lightly here. Heartbreak is everywhere.
Tread lightly here. Heartbreak is everywhere.
164
Nicely said!
2
Thank you. Heartbreak is indeed rampant in premature and still births. It is also there for the parents of children with even relatively mild disabilities. There is no painless "out" when pregnancy fails to end in a healthy, full term birth.
I agree with a lot of the comments here; this one is rough because the same idea can be applied, e.g. for cancer treatments. Should we not discuss better treatmemt for cancer because of all of the people who died prior to the existence of these newer therapies? My heart still breaks for a few of my loved ones who are gone way too early due to the lack of an effective treatment back then. If these wonderful people had made it till today, current target therapies would likely have kept them alive longer. Anyway, the idea is that things change, even neonatal survival rates.
2
As someone who wants a child and is aging out of the possibility, I can't imagine making such an agonizing choice. Door Number 1 leads to imminent death; with Door Number 2 there's hope, but most likely severe disability and health problems. Science and technology has improved our lives, but has also complicated them beyond measure.
132
We all have to make choices in our lives but relying on success in fighting mother nature would be foolish. In other words, face reality and make the best of it and you will no longer fret.
3
My daughter, born at 23 weeks and 6 days, is doing well and is almost two months old actual. She did have one setback: brain bleeds that are common among premature babies, but chances are good that she will have no long-term effects as young brains are resilient and can rewire themselves to deal with damage. I'm continually amazed by how far she's come.
She may have a handicap; she may not. A lot of babies that are as tiny as she is make it these days; we've come a long, long way. But I, too, have a handicap (my hearing, thanks to congenita rubella syndrome); I think my quality of life is just fine.
My heart melted to see the 22-weeker pictured. I have many photos that are very similar. I'll always treasure them.
She may have a handicap; she may not. A lot of babies that are as tiny as she is make it these days; we've come a long, long way. But I, too, have a handicap (my hearing, thanks to congenita rubella syndrome); I think my quality of life is just fine.
My heart melted to see the 22-weeker pictured. I have many photos that are very similar. I'll always treasure them.
46
And how many parents of children who did not survive in similar situations have you visited? And how many children who are severely damage have you judged happy?
20
I am a former NICU nurse. I am so happy that your daughter is thriving. But please understand that there is a big difference between 23 weeks and 6 days and 22 weeks. Every day can make a difference.
21
Jennifer - I am very glad for your good fortune. But, sentiment is not science. It does not invalidate the truth, which this article describes plainly enough: ''a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems, although the vast majority died or suffered serious health issues . . ."
It is understandable that most of the people commenting on this article have happier stories to tell. But, as a doctor I've seen the very sad stories far more often than the happy ones. It is the height of arrogance for a person to project their happy experience onto a scenario that usually results in tragedy. As doctors we do our very best - but there are so many foster children and others in need of adoption out there. At some point - people really have to ask themselves what their real motivation is. Life will force them to confront that question sooner or later.
It is understandable that most of the people commenting on this article have happier stories to tell. But, as a doctor I've seen the very sad stories far more often than the happy ones. It is the height of arrogance for a person to project their happy experience onto a scenario that usually results in tragedy. As doctors we do our very best - but there are so many foster children and others in need of adoption out there. At some point - people really have to ask themselves what their real motivation is. Life will force them to confront that question sooner or later.
4
K writes, 'There is no dollar value to human life; cost should not play a role in the decision to determine viability. '
Would that this were so. Would that we spared no expense educating all children of our nation. Would that we ensured that babies grow up in lead-free homes, so they don't suffer severe and irreversible brain damage. Would that we put no dollar value on people's human need to attain their highest potential, and gave everyone the opportunity, and the means, to succeed. Would that there were dollar amounts on incarceration, for profit healthcare, and charter schools. If cost really should not play a role in determining viability, then we should ensure that all humans are able to live a viable, worthy, happy life. THAT is the true definition of pro life.
Would that this were so. Would that we spared no expense educating all children of our nation. Would that we ensured that babies grow up in lead-free homes, so they don't suffer severe and irreversible brain damage. Would that we put no dollar value on people's human need to attain their highest potential, and gave everyone the opportunity, and the means, to succeed. Would that there were dollar amounts on incarceration, for profit healthcare, and charter schools. If cost really should not play a role in determining viability, then we should ensure that all humans are able to live a viable, worthy, happy life. THAT is the true definition of pro life.
155
What that takes is a mother and father who love each other and love the child. No government can make that happen.
5
The Supreme Court has said that states cannot ban abortion before a fetus is viable outside the womb, and changing that standard could therefore raise questions about when abortion is legal."
Viable without intervention would be the key to legal issues as medical science will likely continue to progress as far as keeping a fetus alive even without the womb via Invitro fertilization, growing fetuses outside the womb. Since this typically requires abortions of significant number of fetuses, something ignored by "antiabortion" ideologues showing the hypocrisy of the ideology.
Viable without intervention would be the key to legal issues as medical science will likely continue to progress as far as keeping a fetus alive even without the womb via Invitro fertilization, growing fetuses outside the womb. Since this typically requires abortions of significant number of fetuses, something ignored by "antiabortion" ideologues showing the hypocrisy of the ideology.
12
Viable without intervention. Exactly.
4
If embryos conceived by IVF become viable via a technology that enables them to be grown outside of the womb, it would make all abortions illegal and would also make destruction of those embryos murder. If a woman decided she didn't want to be pregnant, she would become responsible for providing for the artificial gestation. Be careful what you wish for.
One of the legal arguments SCOTUS accepted was that a fetus that was incapable of surviving outside of his mother had no rights and the mother did. Little did liberals realize that technology would change that threshold.
Sometimes science advances.
One of the legal arguments SCOTUS accepted was that a fetus that was incapable of surviving outside of his mother had no rights and the mother did. Little did liberals realize that technology would change that threshold.
Sometimes science advances.
2
posting as jroll:
"Viable without intervention would be the key to legal issues as medical science will likely continue to progress as far as keeping a fetus alive even without the womb via Invitro fertilization, growing fetuses outside the womb. Since this typically requires abortions of significant number of fetuses, something ignored by "antiabortion" ideologues showing the hypocrisy of the ideology."
This really makes no sense. Viable means that a baby breathes and the lungs inflate. You can't make that happen, it is an involuntary muscular action. Now, once the lungs are inflated, there may be intervention to keep the baby alive. But this could be true of a child born full term or any person at whatever age. What "typically requires abortion of significant number of fetuses?????"
"Viable without intervention would be the key to legal issues as medical science will likely continue to progress as far as keeping a fetus alive even without the womb via Invitro fertilization, growing fetuses outside the womb. Since this typically requires abortions of significant number of fetuses, something ignored by "antiabortion" ideologues showing the hypocrisy of the ideology."
This really makes no sense. Viable means that a baby breathes and the lungs inflate. You can't make that happen, it is an involuntary muscular action. Now, once the lungs are inflated, there may be intervention to keep the baby alive. But this could be true of a child born full term or any person at whatever age. What "typically requires abortion of significant number of fetuses?????"
2
"Saving" children in this fashion comes with a price to all of us.
While financial resources are drained in these essentially heroic and cutting edge endeavors there are costs to all of us that are well beyond monetary.
We begin to think of those who are born free of complications as healthy individuals who are in some way now on their own while in fact, not every healthy child will make it to adulthood or even through childhood without medical problems.
Should the resources of hospitals, staff and procedures that become limited as they are diverted to extraordinary life saving measures having only a selfish or experimental value be denied them?
We are creatures with mental abilities that allow reason and even at the cost of personal sorrow we should use this ability when we consider questions of this sort.
While financial resources are drained in these essentially heroic and cutting edge endeavors there are costs to all of us that are well beyond monetary.
We begin to think of those who are born free of complications as healthy individuals who are in some way now on their own while in fact, not every healthy child will make it to adulthood or even through childhood without medical problems.
Should the resources of hospitals, staff and procedures that become limited as they are diverted to extraordinary life saving measures having only a selfish or experimental value be denied them?
We are creatures with mental abilities that allow reason and even at the cost of personal sorrow we should use this ability when we consider questions of this sort.
5
That is very easy to say when it is not your child. When you stand next to the isolette and look at your tiny newborn you can not think of the cost. Some of these babies do survive and thrive without significant long term effects. Others do not. The problem is that there is no way to determine the outcome when the decisions must be made.
5
it is not easy to say and even less easy to think, but I am only concerned about those children and their parents who will never know family.
While I truly respect your thoughts and the decision you made you are clearly a strong person and your child fortunate to have you as a mother, but you must know better than I the number of children who will be warehoused for their lives because extraordinary measures did not work.
There is a limit to what we as human beings can do and to keep pushing the limit in an already overpopulated world does seem at the least inconsiderate of others and these others are in fact all of our world's children.
This is the cost and it is not measured in dollars.
While I truly respect your thoughts and the decision you made you are clearly a strong person and your child fortunate to have you as a mother, but you must know better than I the number of children who will be warehoused for their lives because extraordinary measures did not work.
There is a limit to what we as human beings can do and to keep pushing the limit in an already overpopulated world does seem at the least inconsiderate of others and these others are in fact all of our world's children.
This is the cost and it is not measured in dollars.
4
Viability is an issue critical to abortion, but was it really necessary to introduce the study results by mentioning their impact on abortion?
Very strange to start an article on the lives and survival of premature babies by mentioning mothers who want to terminate theirs.
Very strange to start an article on the lives and survival of premature babies by mentioning mothers who want to terminate theirs.
64
Yes it is "really necessary to introduce the study results by mentioning their impact on abortion" since this presents a more viable alternative and confirms there is "viable life "earlier than some pro-choice supporters want to acknowledge.
I would think most people on either side of the abortion issue would find this study enthusiastic, but than again once there is medical evidence not in support of a political agenda, validation is then in question.....
I would think most people on either side of the abortion issue would find this study enthusiastic, but than again once there is medical evidence not in support of a political agenda, validation is then in question.....
3
Dear AACNY,
That's a good point, but I think it's to mention a necessary ramification of this technology. With the conservative population's constant push to make abortion illegal, and a conservative majority Supreme Court and Congress, an earlier date for legal abortion's cutoff will result from this.
That's a good point, but I think it's to mention a necessary ramification of this technology. With the conservative population's constant push to make abortion illegal, and a conservative majority Supreme Court and Congress, an earlier date for legal abortion's cutoff will result from this.
10
There is not a conservative majority on SCOTUS. There are four conservatives, who generally vote the law, four liberals who always vote on a purely ideological basis, and one whose opinion can never be predicted. It is absurd to categorize Kennedy as a conservative.
Conservative judges rarely create new laws out of thin air, known as "penumbras" in the liberal lexicon.
If new laws are needed, it's up to the legislature to create them, the executive to sign them into law, and the judiciary to address whether the laws are consistent with the Constitution.
There would be much less of an ongoing battle if the liberals had held up to their end of the bargain, in that the federal taxpayer would not be obligated to pay for an elective medical procedure. Before you go criticizing conservatives, keep in mind that liberals breached the compromise first.
Conservative judges rarely create new laws out of thin air, known as "penumbras" in the liberal lexicon.
If new laws are needed, it's up to the legislature to create them, the executive to sign them into law, and the judiciary to address whether the laws are consistent with the Constitution.
There would be much less of an ongoing battle if the liberals had held up to their end of the bargain, in that the federal taxpayer would not be obligated to pay for an elective medical procedure. Before you go criticizing conservatives, keep in mind that liberals breached the compromise first.
3
Well, if we are going to follow the logic of supreme court decisions, it seems that the point of viability is getting lower. As technology advances, and survival improves, 22 weeks may be the new 24 weeks for elective termination. This lowering of gestational age survivors, may or may not continue (I suspect not unless some breakthrough tech is invented). Interesting concept that technological advances may change the idea of person-hood under the law.
7
At some point this will become a constitutional issue because the current Supreme Court standard for the abortion cutoff is viability. Does a small minority of children born at these premature time points without significant life long issues constitute viability?
19
There is no law that allows euthanasia because someone does not meet your quality standards.
3
"There is no law that allows euthanasia because someone does not meet your quality standards."
But there is -- the death penalty.
But there is -- the death penalty.
7
Have any of you commenting about the costs ever had to make the decision to try and save your baby? The parents are told their chances of survival and all the life saving treatments that will go into that process. There is no dollar value to human life; cost should not play a role in the decision to determine viability.
14
There certainly is a dollar value that can be put on human life. Use an extreme example to demonstrate: What if the cost to save a life wasn't $100,000, or even $1 million, but $10 million or $100 million? Someone has to pay for that, and if it's an insurance company then it means they have to work that into their math such that others would have to pay higher premiums (or not get certain life saving treatments). The fact is that healthcare has very real costs, somebody has to pay those costs, and at a certain point paying unlimited amounts of money to save (or extend) a life siphons money away from other uses. In a world of finite money and resources, what if that $1 million to save 1 premature baby could instead save 1,000 lives by buying food for poor children in Africa, or investing in inner-city school programs that ultimately lead to lower incidence of violence.
I have never had to make the decision to try and save my baby - I pray that I never have to. And of course the life of a loved one is always going to be more valuable to me than that of an unknown person, but by making a blanket statement that costs cannot be part of the decision making process is hiding from the reality of broader societal impacts of those individual decisions.
I have never had to make the decision to try and save my baby - I pray that I never have to. And of course the life of a loved one is always going to be more valuable to me than that of an unknown person, but by making a blanket statement that costs cannot be part of the decision making process is hiding from the reality of broader societal impacts of those individual decisions.
40
Cost isn't measured only by dollars. There's a cost of well being of the child who, if survives, may have a life long set of illnesses including mental disability. There's also the cost to the quality of life of the parents and siblings. Does saving and treating a very ill child at the expense of neglecting older siblings a right decision? I certainly can't answer that question, and that should be left to the parents. The most that we as a society should do is support the parent's decision.
21
I sit in the NICU most days of the week with my little daughter. I regret absolutely none of it and still would not even if I did not have insurance that covers her treatment.
Her life and struggle have taught me to never take anything for granted and my heart melts every time I look at her. She is a treasure and a miracle.
Her life and struggle have taught me to never take anything for granted and my heart melts every time I look at her. She is a treasure and a miracle.
5
This was probably inevitable as medical science continues to advance, but raises the question as to when "treatment" becomes essentially "artificial gestation". Many of those who view human reproduction through a moral lens will have to sort out a traditional ethos that up to now has opposed either abortion or "test tube babies". When does one become the other?
47
This is a delicate, often heart-wrenching subject for both parents and their caregivers. Obviously, there are no easy answers for anyone. Whether we like it or not, cost plays a silent role as well and I make no claim about having the right answers. Backing the clock from the 'generally accepted' 24 weeks, back to 22 or 23 weeks asks even more questions and a a time when many are still trying to grasp the 24 week standards. Even at 24 weeks, the odds of a resounding success remain something less than ideal, so migrating to 22 or 23 does noting to help our understanding or our ethics and practices.
I am not the parent of of a preemie. Now retired, I practiced in a closely related field, but never achieved a comfortable understanding of these difficult choice - and I still do not have a firm set of thoughts and feelings - and may never have.
The professionals of my association have always offered their very best, yet almost universally, they also very quietly note that Mother Nature never intended that every pregnancy end in delivery of a perfect child. In my now distant experience, the only reasonable way to approach the majority of these extremely challenging situations is One at a Time. No two are alike and probably never will be. Compassion, understanding, and as much time as it takes for the parents to express their wishes - are all essential. We (now they) do our best, but there is No Warranty. Mother Nature still governs!
I am not the parent of of a preemie. Now retired, I practiced in a closely related field, but never achieved a comfortable understanding of these difficult choice - and I still do not have a firm set of thoughts and feelings - and may never have.
The professionals of my association have always offered their very best, yet almost universally, they also very quietly note that Mother Nature never intended that every pregnancy end in delivery of a perfect child. In my now distant experience, the only reasonable way to approach the majority of these extremely challenging situations is One at a Time. No two are alike and probably never will be. Compassion, understanding, and as much time as it takes for the parents to express their wishes - are all essential. We (now they) do our best, but there is No Warranty. Mother Nature still governs!
84
As a physician in Colombia, I think those babies had the chance to improve in the order they are deliver in a good conditions. But if we widely recommended that a new gestational age like 22 is the new frontier to treat premature babies is an unresponsable behavior, specially in my country, we have geographic limitations to access to a neonatal unit care. About the study I think we have to analyze all the variables and the causes that precipitate a premature birth and is important to remmber that stressful situations in pregnancy (eg. pre-eclampsy, infections etc) provoke an pulmonary improve in contrast with babies without stressful situations in uterus.
PD: Excuses for my english.
PD: Excuses for my english.
89
Dear Dr. Theran,
Good points, and they also highlight that this type of medical care is going to only be available in the wealthiest areas, underscoring how it is essentially a luxury. And don't worry about your English, your comment was completely understandable. Gracias.
Good points, and they also highlight that this type of medical care is going to only be available in the wealthiest areas, underscoring how it is essentially a luxury. And don't worry about your English, your comment was completely understandable. Gracias.
17
Obviously, the fact that advanced medical facilities and resources are required in order for a 22 week fetus to have a chance of surviving is a material element in a decision regarding what treatment an individual premature infant will receive. Canadian hospitals lack the resources to administer such care for low birth weight infants, which is why women with carrying quintuplets and sextuplets are transported to hospitals with high tech neonatal units in the US prior to going into labor.
As you may have noticed, in the US if it is decided that a fetus at 22 weeks gestation is theoretically viable, it has legal ramifications as to whether an elective (not required for medical reasons) abortion will remain legal for a fetus at 22 weeks gestation.
That in no way impairs a physician from, for example, inducing labor for a woman experiencing preeclampsia when her unborn child is at 22 weeks gestation.
Your English is far superior to my Spanish, you have no need to apologize.
As you may have noticed, in the US if it is decided that a fetus at 22 weeks gestation is theoretically viable, it has legal ramifications as to whether an elective (not required for medical reasons) abortion will remain legal for a fetus at 22 weeks gestation.
That in no way impairs a physician from, for example, inducing labor for a woman experiencing preeclampsia when her unborn child is at 22 weeks gestation.
Your English is far superior to my Spanish, you have no need to apologize.
6
All technology is first available in areas where there is sufficient wealth to create those technologies. Put away your class warfare. If not for the wealthy and well educated everyone would be living with 1950's medical technology.
1
Because you can do something doesn't mean you should do something.
279
True, but medical advances come because somebody pushed the envelope. In 1954, a fetus at 30 weeks had only a 50:50 chance of surviving. Today, that premature infant has a probability of healthy survival almost indistinguishable from a full term infant.
In 1954, someone with occluded cardiac arteries was condemned to a few years as a cardiac cripple, followed by death. Thirty years later, he could be treated to thirty or forty years of a healthy life.
In 1954, someone with occluded cardiac arteries was condemned to a few years as a cardiac cripple, followed by death. Thirty years later, he could be treated to thirty or forty years of a healthy life.
7
Of course I do not want to ever have to make this decision. But this article is misleading in that it does not stress that 22 week fetus' DO NOT SURVIVE without significant medical treatment. Of 78 who had treatment, 60 DIED.
Now to be balanced this article should have told us the cost of this treatment. Health care is all about cost. That is why women with breast cancer cannot receive the most expensive new drugs.
As I have read elsewhere, we need to talk about cost when we are cutting back on benefits to the poor and our existing living children.
Now to be balanced this article should have told us the cost of this treatment. Health care is all about cost. That is why women with breast cancer cannot receive the most expensive new drugs.
As I have read elsewhere, we need to talk about cost when we are cutting back on benefits to the poor and our existing living children.
264
Another thing that bears pointing out, I think. The line that these premature babies "can be treated and survive, in some cases with relatively few health problems." This sounds a lot more hopeful than it is. What it means is, that some of the premature 22 week old fetuses might live, and the ones that live will all have health problems, but some lucky few will have relatively less health problems than the others.
If there were no babies to adopt, this research goal might make some sense. If we were running low on humans, it would be beneficial. As it is, it's a waste of resources and a vanity project.
If there were no babies to adopt, this research goal might make some sense. If we were running low on humans, it would be beneficial. As it is, it's a waste of resources and a vanity project.
207
If you're the parent of a much wanted and loved child this research could make all the difference.
I'm probably you're biggest fan but sometimes I wish you would think a bit before you type.
I'm probably you're biggest fan but sometimes I wish you would think a bit before you type.
18
Thank you. Well said.
11
Once outside their mothers' bodies, these children deserve the same chance for life as you and I receive. Children are not fungible, so it is irrelevant how many children are available for adoption, just as it would be irrelevant how many fifty-year-old Caucasian women are available to "replace" me.
15
There is no mention of the cost of treatment which is an important part of the viability story. Do these hospitals simply treat 22 week old "babies" for free? Is the care given in the months spent in the hospital--four months in intensive care--also free? Is the follow-up care for the years of life for those with severe disabilities also provided for free? If care is not free, who pays? Did the families of Alexis and Micah tell you who paid the costs for their exceptional outcomes?
When states--Missouri and Kansas-- are denying living children food stamps and rent money because their parents are poor, it needs to be a necessary part of hospital decision-making to consider the cost of the extraordinary treatment given to "very premature babies" simply for a scientific experiment. While pushing back the age of viability may be an important accomplishment, all of the costs--present and future--needed to be part of this article.
As a note for reporters, the focus on the "happy ending" stories may make the article uplifting to read, but survival without severe disability is definitely the exception for premature "babies". The article is incomplete and misleading without telling the other less happy stories in proportion to the statistical outcomes. Many people will simply look at the headline and be given ammunition to challenge current public policies while ignoring the actual statistics in the article.
When states--Missouri and Kansas-- are denying living children food stamps and rent money because their parents are poor, it needs to be a necessary part of hospital decision-making to consider the cost of the extraordinary treatment given to "very premature babies" simply for a scientific experiment. While pushing back the age of viability may be an important accomplishment, all of the costs--present and future--needed to be part of this article.
As a note for reporters, the focus on the "happy ending" stories may make the article uplifting to read, but survival without severe disability is definitely the exception for premature "babies". The article is incomplete and misleading without telling the other less happy stories in proportion to the statistical outcomes. Many people will simply look at the headline and be given ammunition to challenge current public policies while ignoring the actual statistics in the article.
459
While I agree that cost is a huge factor in any medical discussion, I reject the distinction that you make between "living children" and these premature children. These premature children are as alive and are every bit as "human" as you and I are. Should we then deny non-palliative treatment to adult cancer patients who have only a slim chance of recovery?
10
Excellent analysis. I would add about the "scientific experiment" comment. How much of the push to lower the age of viability is motivated by care for the baby and its parents? And how much is motivated by a physician's ambition to push the enevelope?
21
Lynda I have submitted a comment in which I note that your comment should become the basis for a series of OpEds dealing with the questions you raise and that Paul Krugman raised in his May 4 column.
As an American living in Sweden where I am a translator and editor for Swedish medical researchers I get to see a medical system at work that is aimed at helping all and does so notably better than the American system in the area of pre, peri, and post natal care.
I know first hand the cases described in today's column and work for researchers here who want to lower even further infant mortality - for example - but as you make very clear the happy ending stories hide a vastly greater number of the opposite.
Thanks
Only-NeverInSweden.blogspot.com
As an American living in Sweden where I am a translator and editor for Swedish medical researchers I get to see a medical system at work that is aimed at helping all and does so notably better than the American system in the area of pre, peri, and post natal care.
I know first hand the cases described in today's column and work for researchers here who want to lower even further infant mortality - for example - but as you make very clear the happy ending stories hide a vastly greater number of the opposite.
Thanks
Only-NeverInSweden.blogspot.com
6
“Many (babies) who have survived have survived with severe handicaps.”
And there's zero mention of the hundreds of thousands of neonatal medical costs for each of these premature births as well the associated life-long medical costs of pre-mature births.
"Of the 755 babies born at 23 weeks, active treatment was given to 542. About a third of those survived, and about half of the survivors had no significant problems".....and the other sixth that survived did in fact have significant problems.
Sometimes it's better to listen to Mother Nature instead of creating a massively handicapped life and amassing unpayable medical expense and debt in the process.
And there's zero mention of the hundreds of thousands of neonatal medical costs for each of these premature births as well the associated life-long medical costs of pre-mature births.
"Of the 755 babies born at 23 weeks, active treatment was given to 542. About a third of those survived, and about half of the survivors had no significant problems".....and the other sixth that survived did in fact have significant problems.
Sometimes it's better to listen to Mother Nature instead of creating a massively handicapped life and amassing unpayable medical expense and debt in the process.
359
I agree completely Socrates. Said much the same too, but maybe I put it more offensively. This is not a wise way to expend resources, and it's a very tough truth to absorb, but death must be accepted by people.
15
Showing up too early or staying on too long. Much suffering and incredibly expensive.
16
So, you don't get medical care unless there is a 100% chance of success. Listen to mother nature?
3
" in some cases with relatively few health problems"- the consequences of such a premature birth are typically significant and lifelong. Blindness and permanent lung damage are common. Cerebral hemorrhages are common. The typical costs are millions in NICU care and millions in lifelong disability care.
Parents should think very hard about playing this lottery. We shouldn't treat babies as physiology experiments , we should be realistic and humane.
Parents should think very hard about playing this lottery. We shouldn't treat babies as physiology experiments , we should be realistic and humane.
293
So who would you like to make this decision? The parents or the government?
3
Parents of course. I was referring to possible plans to push back to 23 weeks rather than the current 24.
3
When do you think the government gets to make that decision? Even parents don't get to make the decision if the baby is a live birth in a competent hospital. Once the child is born alive, the medical system takes over to attempt to support that life. The article doesn't have numbers (Americans hate numbers), but it does say that "some" babies will survive with few lasting problems. What about the babies who survive with major problems? My niece was born at 23 weeks and survived but is blind and mentally handicapped.
The government DOES NOT make the decision to keep the child alive or to kill the child--the hospital does.
The government DOES NOT make the decision to keep the child alive or to kill the child--the hospital does.
61
The parents should make a decision. In response to Priscilla, the idea that the hospital takes over care and that neither the parents nor the government has a say in it, is not 100% correct. While parents can't kill the baby - that would be murder - they have the right to say stop the treatment and let Mother Nature take its course. We do it with adults, there's no reason not do it with infants.
6
From a parent's point of view I can't even imagine having to make such a decision. However from the medical communities point of view just because you 'think ' you can to do something doesn't mean you should. The odds are still not good in terms of outcomes. One has to wonder how the docs and hospitals would feel if they had to accept financial responsibility going forward.
187
On the other hand, as a rule, I'd prefer the medical community always be moving in one direction, that of prolonging life.
When tough decisions are being made and unknowns dominate, isn't it better to be able to count on the medical community to approach the decision first from the perspective of what can be done to save or provide life instead of resources or other principles?
Better a guiding principle of life, with exceptions made based on individual circumstances than the other way around.
When tough decisions are being made and unknowns dominate, isn't it better to be able to count on the medical community to approach the decision first from the perspective of what can be done to save or provide life instead of resources or other principles?
Better a guiding principle of life, with exceptions made based on individual circumstances than the other way around.
2
I intended this as a general reply, but my browser only gives me the option of replying to specific prior postings.
The decision to treat or not treat a premature infant should be a private one, that of the family involved, but the costs of treatment and subsequent care of the child should also be strictly private and assumed in their entirety by the family of the infant. These costs should not be passed on to the public in the form of higher taxes and health insurance costs. There are also the social costs struggling municipalities faces when providing special schooling and services to a few individuals disabled by their prematurity, results in cut backs to the services it provides to the rest of the community.
The decision to treat or not treat a premature infant should be a private one, that of the family involved, but the costs of treatment and subsequent care of the child should also be strictly private and assumed in their entirety by the family of the infant. These costs should not be passed on to the public in the form of higher taxes and health insurance costs. There are also the social costs struggling municipalities faces when providing special schooling and services to a few individuals disabled by their prematurity, results in cut backs to the services it provides to the rest of the community.
The parent has no say in the decision. If a hospital deems your fetus viable, they will force treatment on it. Even if against the parents' wishes.
2