USA Today Examines ‘How Far to Go’ to Save Pre-Term Infants

As scientific advances allow more premature babies a greater chance of survival, physicians and parents are increasingly faced with difficult decisions regarding how far to go to save premature infants, who run a high risk for disabilities, USA Today reports. In the United States, increased use of artificial insemination has led to an "explosion" of multiple births, which often result in premature deliveries -- babies born before 37 weeks gestation or weighing less than five and a half pounds. Today, one in nine babies is born prematurely. Premature infants do not have fully developed lungs or hearts, which often requires doctors to perform resuscitation procedures to keep them alive. But recent advances in research and technology have "dramatically improved" survival rates for "preemies" born as early as 23 weeks gestation and weighing under one pound. About 80% of infants born at 25-28 weeks gestation survive, but the number drops to 25% for babies born at 23 weeks gestation. While these survival rates would not have been possible a decade ago, the numbers have "come at a cost," with many surviving premature babies running high risks for disabilities and health problems. A study published last August in the New England Journal of Medicine revealed that "severe disability is common among children born as extremely (premature) infants," with more than 50% of babies born at 25 weeks or earlier monitored in the study experiencing "severely delayed development" at 30 months of age. About 10% of the children had "severe neuromotor disability," and 7% were blind.

Ethical Conundrums
The high risk of birth defects has led many parents and physicians to question whether doctors and hospitals should take excessive lifesaving measures to save all premature babies. Physicians say the choice is "difficult" because some infants survive with "no apparent problems" and some may develop problems that "are inconvenient but not disabling." Some doctors have deferred the decision to resuscitate premature infants to the child's parents. Dr. Marilee Allen, a pediatrician at Johns Hopkins University Hospital whose son was born prematurely, said, "I feel strongly that it should be the parents' choice. They are the ones that are going to have to live with the results of the decision." Other physicians, however, are "reluctant" to take lifesaving measures for infants born before 24 weeks gestation and work with parents on a "case-by-case" basis for babies born between 24 and 26 weeks. Dr. Barry Fleisher, a pediatrics professor at Stanford University, calls that two-week period "the gray zone," adding that "most (doctors) ... would resuscitate if that's what the parents wanted." However, some hospitals and advocates for the disabled believe that all premature infants should receive resuscitation, regardless of the possible risks. James Bopp, president of the National Legal Center for the Medically Dependent and Disabled, said, "Since when did we come to expect that we are all entitled to perfect children? ... To sentence [children] not to live because they might have a condition that we'd prefer they not have ... is unconscionable."

Letter of the Law
The law regarding how far to go to save premature infants is "cloudy." For instance, a Texas statute awards preemies the same "rights, powers and privileges" as full-term babies, but "few other states are as explicit," according to University of Texas law professor John Robertson. While a 16-year-old federal law prevents "withholding care from a child because of a disability," advocates for the disabled say that law has "never been used in an infant resuscitation case," and criminal laws are "rarely used against parents who help their [premature babies] die." But many hospitals attempt to treat all premature babies for "fear of lawsuits from parents who demand" revival procedures for their preemies, "even when doctors believe there is no hope," USA Today reports. Attorney John Serpe said, "Doctors in these situations deserve some clear-cut direction. They have so much on their minds in these situations. You can't handcuff them in the delivery room. And you can't ask them to be lawyers and judges, too" (Willing, USA Today, 11/29).