Posted on 10/23/2009 6:08:31 AM PDT by rhema
The Daily Mail from the UK reports that a woman in Great Britain held her baby for two hours until he died while doctors stood by, refusing to help. Why? Because he was born two days too soon. Guidelines in Britain hold that any baby born prior to 22 weeks not be resuscitated because such resuscitation would be futile and the baby would die anyway. Little Jayden was born at 21 weeks and 5 days.
Even if the mother pleads for help? Which she did? Sorry—no can do—was the message to her.
Such is the effect of clinical care guidelines on medical practice, guidelines in Britain developed by a think-tank called the Nuffield Council on Bioethics, guidelines that extinguish human compassion from the care equation and provide cover for doctors to deny care and for the National Health Service (NHS) to save money. Jayden was born and died on Oct. 8, 2008. His mother, Sarah Capewell, now leads a campaign to change NHS policy on treating premature babies.
As an OB-GYN, I find it difficult to picture an actual physician refusing a patient's plea in such a circumstance. Theory is one thing. But standing toe-to-bed watching a mother holding her dying child and saying no chills my soul.
Extreme prematurity is not an easy issue. The earliest survivals on record occurred at 21 weeks 5 days and 21 weeks 6 days. Many times, the babies who survive such prematurity are left with lifelong physical and mental disabilities and always the cost of such care startles our fudiciary sensibilities. (Over $1 million is not unheard of.) Thus, those who see no value in imperfect life or fail to see the worth of expensive life often carry the day in committees that set guidelines.
The Daily Mail article describes the British Association of Perinatal Medicine doing some fast backtracking following this incident and the mother's complaint, saying the guidelines were not meant to be a "set of instructions." But guidelines soon become protocols and protocols morph into rules; rules that, if broken, require explanations and result in discipline for the rule-breaker. Rules that, if followed, save the NHS millions of pounds.
There have been times I've told mom and dad that resuscitation would be futile and that they should cherish the short time they have with their child prior to his passing. I've never fallen back on a guideline to justify my actions, however. I've simply told the parents the baby would not, could not survive our best efforts. But I've also never turned down a request to help a baby if asked.
One night in my residency, a young woman experienced preterm labor. She was deemed too early for intervention (but was close to the line) and went on to experience an unsuspected breech birth, which I attended. Unfortunately, the baby's head became stuck in the mother's cervix, making delivery impossible and death certain for the struggling premature baby. I cut the mother's cervix to release the baby's head, much to the parents' relief. The baby died in spite of resuscitation efforts. Although my superiors criticized this intervention, I can still see the faces of the parents as their baby struggled and wiggled, half in and half out. I've no doubt I did the right thing.
The medical cutoff for extreme prematurity is a target in motion, with modern technology resulting in survival of more and more premature babies. Such a moving target contradicts hard and fast rules and should require the best judgment of those physicians at the bedside. Doctors should bring together all the information possible—the stage of the baby's development, the parents' wishes, the availability of treatment, the doctor's skills—then reach a compassionate and appropriate decision with mom and dad on board.
—Matt Anderson is a practicing OB/GYN in Minnesota and blogs regularly at mdviews.wordpress.com
First, I will do no.........oops, never mind..........
as a doctor who emergently delivered a 20 wks. old breech baby, who went on to survive without any neurologic or developmental deficit a few years back, I would argue that we must give all newborn life a fighting chance. I didn’t think that this kid would survive but I was proven wrong. I just threw the kitchen sink at him and God took care of the rest.
The first thing you have to realize is that in Britain doctors are basically government employees. They are not going to put in any more effort than necessary to keep their jobs.
Good job! You know that under the coming system you will be required to throw that baby IN the kitchen sink... saves money you know?
Simply amazing! Thank you for your service as well!
Note to all - we should be thanking good health care workers as well as our soldiers for similar reasons - both for protecting the sanctity of life!
Thank you so much. As a mother I can’t imagine holding my baby and begging for help and being rebuffed. I have tears in my eyes just thinking about the possibility.
I went into her unit (26 beds) for the first time the other day. Standing in front of each isolette, one cannot help but feel a great desire to reach out and help them. It is simply overpowering.
I started singing a soft low tune to one little girl in front of me. Her eyes opened immediately with evidence of attentiveness and obvious pleasure. Then there was another, who looked like a dark lump on a pillow. She died that night unexpectedly. There have been a lot like her lately.
Although it is physically a very pleasant place, I can't imagine working there.
Allowing a baby to die kills the very person for whom Social Justice is needed.
First do no harm. How can a doctor be so heartless?
The very heart and soul of humanity is to reach out and help others. Even if it means breaking the “rules.”
To sear one’s conscience to such a degree that one cannot take pity on a suffering human being and try to help with every resource available . . . is to be “dead man walking.” Such a physician needs to give up his practice and find another line of work which does not entail contact with other humans.
Heartless and Inhumane. These are words we must use when emailing our Congress Critters regarding the Health Care Bill.
Words fail me.....
This is the ultimate evil of collectivism--confiscating property from innocent citizens is bad enough but what is worse is it dehumanizes its subjects.
Really? Any particular reason you didn't choose to publish this extraordinary experience as a case study? After all, it's almost 2 weeks earlier than any survival on record, with or without severe deficits, and if it could have been documented as true, it certainly would have impacted policies at many hospitals around the world by providing justification for lowering the minimum gestational age for attempts to be made to save premature babies.
I call BS on this claim, and frankly think it's disgusting when people go around making claims like this. Among other harm, it leads some parents to the mistaken belief that their doctors could actually have saved their extremely premature baby, but simply refused to do so.
Many of us in the real world are too busy taking care of patients to give a flying rat’s arse about publishing. I have no desire to submit anything for publication because it is a laborious process that detracts from the valuable time I can spend with my patients and more importantly, my family. If you think that the record for the youngest surviving fetus is at 21 - 22 weeks you are mistaken. Ask any neonatologist about their personal experience and they will confirm to you that they have successfully saved a few 20 weekers in their career and some grow up to have normal lives. 20 wks. is actually the cut off that many centers use to decide whether or not to resuscitate. I have personally seen an 18w+ premie survive, but not without significant developmental problems necessitating numerous surgeries. Just because you don’t read about it nor see it on TV doesn’t mean that it didn’t happen. Not everyone care to publish, nor does every parent of a premie want public notoriety.
Publication of a case study does not entail disclosing the identities of the parents or babies. Publication of information that is likely to guide the medical profession around the world towards practices which will save more patients’ lives, is as much an ethical obligation as working directly to save the patients in front of you. Writing up a case study for publication is hardly a big laborious process. As someone who has been the subject of a published case study, I know what it entails and it’s a snap compared to publication of papers describing multipatient clinical trials or retrospective analyses. The only hitch is that you can’t just make totally unsubstantiated claims the way you can when posting on an internet forum.
I had a 25 weeker 23 years ago and he survived, back when that early had survived only a few times. People I have run into have claimed that someone they knew, or an older relative, had lived in a shoebox, warmed near the stove, born at 6 mos (because they were 3 months early, but that made them 7 mos)
To this day, son does not so much as wear glasses, but I don’t know about your claim. It seems that making medical history would have encouraged you to publish this.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.