Caring for Premature Babies: Cruel?

[Newbie2]

Ummm no I think we are just trying to point out that the vast majority of premies alive today probably aren;t the extreme 21-23 week cases.

However about the inconvience and money thing…I do personally think that the time and money could be better spent on people that actually have a decent chance of survival. We have to remember that yes time money and medical resources are limited. So it;s not just a matter of a little inconvience to care for these extreme premies. It could also mean that less time money and medical resources are going to those that actually have a good chance at survival. So for me it is a matter of compassion as well as time and money and resources. Which I will point out once again are limited.

Yep, decrease the surplus population.

and just give them the old folks, AIDS patients, and cancer patients a pain pill.

 

[Mary_Gail_36]

My DS was born at almost 29 weeks.

During the process of trying to stabilize me, the baby looked like he was closer to 28 weeks. The chief of obstetrics said to me, “We are going to try to keep him in as long as possible…28 weeks we are basically talking just survival.”

Then the nurses talked to me. One said she had a 23 week preemie survive…another cared for a 23 week preemie…she then saw her in the supermarket years later running around all happy.

My baby went through a fair amount of suffering, a central line put in, a ventilator, a spinal tap.

I’m not a doctor, but what I learned is that the beginning hours are the most crucial. If a 21 week baby survives the birth, an isolette, fluids, and help breathing don’t seem to be too cumbersome. Often they don’t survive. In the course of my lifetime, babies like my son didn’t survive either. But he is beautiful, and doing very well. I’m glad that some where along the line, doctors put in the effort to save these babies and give them a chance.

 

[DOShea]

My wife was a NICU nurse at a Catholic hospital until changing jobs just a few months ago. She worked there for years.

I can tell you this firsthand… I never had a bad day at work (comparatively) when I came home and ministered to her emotional and spiritual needs from what she had to deal with during her work day. Frankly, I don’t know how anyone does it. I know it must take a virtual waterfall of God’s grace to work and want to work there.

The guidelines used there were 19 weeks or less meant no external measures used to try and save the baby.This seems cruel, but the fact is, the baby is not developed enough to live even with the most herculean measures. 20 weeks and above, they will try if the parents wish, even in the face of such low probability of success. At 22 weeks and above, they pull out all the stops to save the child. To date, they youngest child to survive attempts (even when 19 was not established as a limit) was 20 weeks. That child lived, spending more than 2 years in the hospital under intensive care conditions, and has many severe health problems that will never “fix” themselves. I don’t know, honestly, if that child is still even alive.

It should be noted that all of this is discussed with the parents ahead of time. Certain medical realities are not changed by human intention. At 19 weeks, medications that work in a developed baby sometimes have no effect because the necessary internal structures necessary for the chemistry to work simply are not there. These are not things one can “see” with a scan, it would take microscopic dissection to determine it, and even that can be guesswork.

As the 2nd article points out, sepsis is a giant problem. Immune systems aren’t completely in place, and the mere piercing of skin to supply fluids can mean the initiation of an infection that takes the life of the premature infant. Imagine how the nurse who started that IV feels when that happens? And I could name you 5 or 6 more situations just like it that where the mere application of the treatment can be the cause of death. After a few of those happening to you, what would go through your mind when you are the one who must carry out the doctor’s orders to initiate a procedure that might kill the tiny life you hold in your hand? Are you the compassionate hand of life, or are you the sinister hand of death? Who wants to sign up to face that every day?

It is never easy. Just as the thought of “Is my doing this going to kill this baby?” haunts one, so does the thought of “Will this baby die if I don’t?”

So this is not just a matter of looking to some doctrine or ideal and following it in lockstep fashion where it applies everywhere and always without exception and without forcing individual souls to suffer the consequences. Suffering abounds in these situations, and only in the rare instance does it result in situations where the individual exceeded all medical expectations. The usual case is, just as predicted, the child has huge health problems and likely will not survive very long with even the most advanced care. It isn’t the care, it isn’t the expense, it isn’t the doctor’s skill that determines these things. It is the stage of development of the infant and their ability to grow external to the womb, something that differs in each case just as it does in adults with recovery from a surgery.

These limits were not picked out of a hat. Attempts to save younger infants have been tried and failed. There is a point where even the most noble attempts to save just will not. As a result, we have to face the reality that this is God’s design, and like every other problem in life we face, we have to make decisions and be accountable for them. Such is the case with these kinds of policies that may appear cruel and uncaring at first glance.

My advice to anyone grasping to understand these issues is to go spend some time talking to the medical professionals who have to carry out this work. See what they do and learn why they think as they do before outright condemning them because you don’t think what they do matches some words in a teaching of faith. I believe you find out they are actually more respectful of that teaching then you might think, and they suffer in ways you would never want to. Pray for them.

 

[dixieagle]

Maybe I’m missing something here. Why should money and resources have anything to do with saving a human life ? Typical world where the greed of money is everything even to hospitals and medical professionals.

I think we tend to forget that the Church does not require that extraordinary means be used to extend life, and virtually all of these micropreemies (21-22 weeks) would require the most extraordinary means to live even a few hours or days:

“Normally one is held to use only ordinary means – according to the circumstances of persons, places, times and culture – that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as one does not fail in some more serious duty.” - Pope Pius XII in an address to Catholic physicians. lifeissues.net/writers/mis/mis_12ordinaryandextra.html

I think that compassion and common sense must both come into play.

 

[dixieagle]

My DS was born at almost 29 weeks.

During the process of trying to stabilize me, the baby looked like he was closer to 28 weeks. The chief of obstetrics said to me, “We are going to try to keep him in as long as possible…28 weeks we are basically talking just survival.”

Then the nurses talked to me. One said she had a 23 week preemie survive…another cared for a 23 week preemie…she then saw her in the supermarket years later running around all happy.

My baby went through a fair amount of suffering, a central line put in, a ventilator, a spinal tap.

I’m not a doctor, but what I learned is that the beginning hours are the most crucial. If a 21 week baby survives the birth, an isolette, fluids, and help breathing don’t seem to be too cumbersome. Often they don’t survive. In the course of my lifetime, babies like my son didn’t survive either. But he is beautiful, and doing very well. I’m glad that some where along the line, doctors put in the effort to save these babies and give them a chance.

How wonderful that your son is doing well. We have a friend who gave birth in April to a 25 week baby girl; she is still in the NICU, but hanging in and making progress. Evidently, boys tend not to do as well as girls, for some reason.

What you suggest is perfectly reasonable - warmth, fluids, CPAP or nasal cannula. I would consider those ordinary means that should be offered to any preemie - even at 21 weeks - who survives birth.

 

[dixieagle]

Low chance of survival (well, no one is going to leave this world alive)
Painful treatments
Possibly disabled afterwards

With those criteria, we should stop treating cancer patients. And we should also just let the AIDS patients die as well as those with spinal cord injuries, organ transplants – the list could go on for quite some time.

These cases are simply not comparable to a 21 week micropreemie whose organs haven’t even developed enough to survive. With most cancers, there is at least some reasonable hope for survival, and with many, an excellent chance. Same for AIDS patients these days, with the new drug cocktails.

 

[dixieagle]

I am still concerned about our society’s sense that all heroic measures should be taken so preserve life and that a doctor that doesn’t do so is somehow negligent. Technology that could fully replicate a mother’s womb is not something I dream about happening. Imagine where we would be with IVF and then artificial wombs! And yet still, people as a whole would be demanding the ‘right’ to abortion just as they demanded the ‘right’ to the perfect baby born without any inconvenience to themselves. Shiver!

It just becomes one more step on the march to saying the life we do want needs to be perfect and the lives that aren’t can be snuffed out through abortion or euthanasia.

You’re absolutely right, of course.

 

[Mrs_Sally]

I think we tend to forget that the Church does not require that extraordinary means be used to extend life, and virtually all of these micropreemies (21-22 weeks) would require the most extraordinary means to live even a few hours or days:

“Normally one is held to use only ordinary means – according to the circumstances of persons, places, times and culture – that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as one does not fail in some more serious duty.” - Pope Pius XII in an address to Catholic physicians. lifeissues.net/writers/mis/mis_12ordinaryandextra.html

I think that compassion and common sense must both come into play.

Thank you for giving us this quote. I think we also need to realize that not every hospital and certainly not every country has the means to take these extraordinary measures. Let us all say a prayer tonight for the parents or premies, the drs and nurses who care for them, and for the teeny babies themselves.

 

[Timbothefiveth]

there not some threshold beneath which survival is simply impossible, due to underdeveloped organ systems?

No, because everyone here was in that stage at some time.

Preemies of 21-22 weeks gestational age have between 0-10% chance of survival;

If you were shot and had a 10% chance of survival, would you want the doctors to just abandon you?

Of the minuscule number of 22 week babies who survive, there are few who would be able to tell you “they’re glad they went through it”, as they are so often profoundly disabled.

Someone being disabled doesn’t justify killing them.

We’re not talking about preemies who were born just a few weeks early, but those at the extreme edges of viability. This is an issue that requires serious thought, in light of Catholic teachings on the value of each human life, the difference between ordinary and extraordinary means, and our belief in eternal life.

That shouldn’t matter in this case. Whether or not they will live eternally, we still owe them a shot at life here. It is far more cruel to just let someone die.

 

[s4angel]

I read this article… I am in a state of shock that the doctors did not attempt to stop the labour. I may not be right about this but if a child is born that premature but is showing signs of trying to breath on its own, moving its arms and legs and is basicaly strong by all accounts I read then I feel it is a travesty not to supply the medical assistance needed.

Doctors make these dicision now. I know because I experianced it. If your child will be profoundly retarded then good luck finding someone to perform surgery to save its life even if that child is full term. Look at the stories of children born with Trisomy 13 or 18 they are denied surgeries that would save thier lives, The statistics say only 10% of those baby’s make it to thier first birthdays but they do not give the reason as being that they are denied medical care because they will always be profoundly mentaly retarded.

this story makes me upset that the very same thing could happen in america (more than it already does) Woman who go into labour should be given medications to stop labour no matter if they are only 16 weeks or 20 weeks just as the attemp is done at 30 weeks and above. that to me is the real tragedy of this story.

 

[Debra_C]

I would have to say that I can agree with the nurse that sometimes there are things worse than death. BUt I think how far we should go in caring for premature babies has to be handled on a case by case basis. I

had a friend whose second child was born with only two functioning heart chambers. A surgeon convinced them he could fix her heart. after two open heart surgeries before this premature infant was even 3 days old, he was already planning the next. Finally the father asked what are the chances, really? How many times have babies in this condition been saved? He siad oh, never, but I’m sure I can do it. They concluded then that the baby and the family had already gone through enough and asked them to stop the effort. They loved and cuddled their child for another day and a half before she finally died.

My point is, sometimes an ambitious doctor’s curiosity or drive to stretch the limits will lead him/her to use an “interesting patient” as a guinea pig with little thought to the suffering of that patient or their family. But certainly, every life is precious, and every live born child should at least be received with love and given palliative care, even if there is no hope that medical intervention will save his life. And if there really is hope, by all means, try.

 

[centurionguard]

I think we tend to forget that the Church does not require that extraordinary means be used to extend life, and virtually all of these micropreemies (21-22 weeks) would require the most extraordinary means to live even a few hours or days:

“Normally one is held to use only ordinary means – according to the circumstances of persons, places, times and culture – that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as one does not fail in some more serious duty.” - Pope Pius XII in an address to Catholic physicians. lifeissues.net/writers/mis/mis_12ordinaryandextra.html

I think that compassion and common sense must both come into play.

I think we tend to forget that the Church does not require that extraordinary means be used to extend life

And I wonder just how far the church loosens its definition in defining (“ALL”) the extraordinary means of exhausting all the efforts to extend life ?

Was it wrong of my families wishes (“my mother in particular”) to stop a doctors wishes
of stopping life support of her beloved husband who was involved in a tragic accidental
fall from the bell tower in our Parish causing a terminal situation whereby my father would require 24/7 nursing care and full life support before my family decide to bring him home
even if it meant that my father might die soon afterward. We did bring him home under 24/7 nursing care in our home with full ventilated life support. My father did live out the Dark Night of the Soul in those eleven years with the tender love and compassionate love
of his family and nursing staff at his side. And my father through those many years of suffering enjoyed the immense love and companionship of his family being close beside him even though he had absolutely no quality of life. Were we wrong of bringing him home or should have we let the doctor eleven years earlier pull his life support from him ? This is a huge moral questionable dilema that’s not so easy to define anymore than it would be exhausting all resources possible to the strictest degree extending the life of preemies. As I stated before in a earlier post, Suffering is a definitive prerequisite of life that nobody in this world can escape.

 

[Nowhere_Man]

I was born at 27 weeks. I had three brain hemorrhages, a double groin hernia, was lacking oxygen, and was told I would NEVER walk… Now, 16 years later my only detriment is VERY mild Cerebral Palsy and a VP Shunt to drain excess brain fluid. My walking is sufficient for normal use. I’ll probably never be a triathlete but I can do everyday activities with ease, although I walk a little slower than the average person.As for my intelligence, the state says I am ‘above-average’.

 

[Mary_Gail_36]

I was born at 27 weeks. I had three brain hemorrhages, a double groin hernia, was lacking oxygen, and was told I would NEVER walk… Now, 16 years later my only detriment is VERY mild Cerebral Palsy and a VP Shunt to drain excess brain fluid. My walking is sufficient for normal use. I’ll probably never be a triathlete but I can do everyday activities with ease, although I walk a little slower than the average person.As for my intelligence, the state says I am ‘above-average’.

God bless you! I have a special place in my heart for preemies, I have my own!

 

[DOShea]

No, because everyone here was in that stage at some time.

And most of us had our needs supplied via an umbilical connection to a fully-functioning adult system that took care of nourishment, oxygenation, blood chemistry, and immune functions. That is not the same when one is outside the womb on their own when none of these systems fully function on their own.

If you were shot and had a 10% chance of survival, would you want the doctors to just abandon you?

Certainly not. But this is neither a case of 10% chance of survival nor of doctors abandoning you. If you want a valid comparison, it might be more like this: If you were injured in a way that completely destroyed 90% your lungs, disrupted much of your brain function, destroyed your immune system to the point where even the injection of an IV could kill you in hours, nutrients could cause damage that will be irreparable, drugs are unlikely to even have any effect, including pain medications, would you want medical professionals conducting procedures on you round-the-clock, day-after-day, month-after-month, when you have less than one in a hundred thousand chance to survive even the medical care? And would you want your family to have to see that and live with the anguish every day and night that rather than helping you, they are responsible for torturing you?

Someone being disabled doesn’t justify killing them.

Certainly not, and we aren’t dealing with disabled, we’re dealing with UNabled, which are different. You cannot force function and development where it doesn’t exist, and it is not just a matter of waiting around or giving some care.

That shouldn’t matter in this case. Whether or not they will live eternally, we still owe them a shot at life here. It is far more cruel to just let someone die.

Would you feel this same obligation to a 5-day old fetus external to the womb? How about a 2-month old fetus? What is it you image can be done for them at this stage? You have to draw a line where impossibility presents itself, and that is totally different than imposing an arbitrary limit where no physical limit exists.

The hospital I mentioned in my earlier post has tried to save prematures with all the effort they could muster at ages less than 20 weeks. They were never able to succeed. Never. So now they no longer attempt it. That’s completely different than a scenario where they would make an arbitrary decision to cut off support at, say, 25 weeks where there IS possibility of survival below that number.

 

[dixieagle]

I was born at 27 weeks. I had three brain hemorrhages, a double groin hernia, was lacking oxygen, and was told I would NEVER walk… Now, 16 years later my only detriment is VERY mild Cerebral Palsy and a VP Shunt to drain excess brain fluid. My walking is sufficient for normal use. I’ll probably never be a triathlete but I can do everyday activities with ease, although I walk a little slower than the average person.As for my intelligence, the state says I am ‘above-average’.

Wonderful! God bless you.

 

[dixieagle]

And I wonder just how far the church loosens its definition in defining (“ALL”) the extraordinary means of exhausting all the efforts to extend life ?

 

[Calliso]

My wife was a NICU nurse at a Catholic hospital until changing jobs just a few months ago. She worked there for years.

I can tell you this firsthand… I never had a bad day at work (comparatively) when I came home and ministered to her emotional and spiritual needs from what she had to deal with during her work day. Frankly, I don’t know how anyone does it. I know it must take a virtual waterfall of God’s grace to work and want to work there.

The guidelines used there were 19 weeks or less meant no external measures used to try and save the baby.This seems cruel, but the fact is, the baby is not developed enough to live even with the most herculean measures. 20 weeks and above, they will try if the parents wish, even in the face of such low probability of success. At 22 weeks and above, they pull out all the stops to save the child. To date, they youngest child to survive attempts (even when 19 was not established as a limit) was 20 weeks. That child lived, spending more than 2 years in the hospital under intensive care conditions, and has many severe health problems that will never “fix” themselves. I don’t know, honestly, if that child is still even alive.

It should be noted that all of this is discussed with the parents ahead of time. Certain medical realities are not changed by human intention. At 19 weeks, medications that work in a developed baby sometimes have no effect because the necessary internal structures necessary for the chemistry to work simply are not there. These are not things one can “see” with a scan, it would take microscopic dissection to determine it, and even that can be guesswork.

As the 2nd article points out, sepsis is a giant problem. Immune systems aren’t completely in place, and the mere piercing of skin to supply fluids can mean the initiation of an infection that takes the life of the premature infant. Imagine how the nurse who started that IV feels when that happens? And I could name you 5 or 6 more situations just like it that where the mere application of the treatment can be the cause of death. After a few of those happening to you, what would go through your mind when you are the one who must carry out the doctor’s orders to initiate a procedure that might kill the tiny life you hold in your hand? Are you the compassionate hand of life, or are you the sinister hand of death? Who wants to sign up to face that every day?

It is never easy. Just as the thought of “Is my doing this going to kill this baby?” haunts one, so does the thought of “Will this baby die if I don’t?”

So this is not just a matter of looking to some doctrine or ideal and following it in lockstep fashion where it applies everywhere and always without exception and without forcing individual souls to suffer the consequences. Suffering abounds in these situations, and only in the rare instance does it result in situations where the individual exceeded all medical expectations. The usual case is, just as predicted, the child has huge health problems and likely will not survive very long with even the most advanced care. It isn’t the care, it isn’t the expense, it isn’t the doctor’s skill that determines these things. It is the stage of development of the infant and their ability to grow external to the womb, something that differs in each case just as it does in adults with recovery from a surgery.

These limits were not picked out of a hat. Attempts to save younger infants have been tried and failed. There is a point where even the most noble attempts to save just will not. As a result, we have to face the reality that this is God’s design, and like every other problem in life we face, we have to make decisions and be accountable for them. Such is the case with these kinds of policies that may appear cruel and uncaring at first glance.

My advice to anyone grasping to understand these issues is to go spend some time talking to the medical professionals who have to carry out this work. See what they do and learn why they think as they do before outright condemning them because you don’t think what they do matches some words in a teaching of faith. I believe you find out they are actually more respectful of that teaching then you might think, and they suffer in ways you would never want to. Pray for them.

Wow excellent post!

 

[centurionguard]

centurionguard;5712401:

Clearly, your family loved your father very much and was willing to shoulder the terrific burden of seeing him in such a state, with “absolutely no quality of life.” At the same time, it would not have been wrong to let nature take its course at the time of his accident, if he had no hope of living without a ventilator, etc.

While none of us can completely escape suffering, I have serious qualms about inflicting suffering upon others when the situation is - to the best of our knowledge and abilities - hopeless. (And I am speaking here of the 21-22 week preemies, and of myself, were I in such a situation.) As Catholics, we must not lose sight of the fact that we are, ultimately, destined not for this world, but for the next.

I would tend to agree with you for the most part without question.

I have serious qualms about inflicting suffering upon others when the situation is - to the best of our knowledge and abilities - hopeless.

However your statement above which I have no problem understanding and in some part I would conclude that you are for the most part seemly correct in what you state.
Yet; I find some conscious part of me asking who are we to play God halting suffering by pulling the plug on human beings even if such circumstances look grim and inevitable.
Is not God the ultimate giver and taker of human life without the intervention of humans deciding the beginning and finality of life no matter how well intention the human heart is.
I myself do not like to see other human beings suffer. It’s profoundly heartwrenching.

I remember very clearly the day of my fathers terminal accident while he had been comatose in and out of consciousness. On the evening of the third day after the accident
Being his eldest son I went into the Neuro Intensive Care Unit room alone where he was hospitalized.
As I stood close to the bedside are eyes met as he could not speak being fully ventilated on life support. I strongly sensed his eyes which kept motioning me to look at the ventilator.
I knew he wanted me to shut it off. I went home later that night feeling great sadness, guilt and a coward because I did not have the courage to remove him from life support.
If situations would have been reversed I would have wanted my father to do the same for me.

 

[Ceil-1]

Perhaps we should spend some effort dealing with** why resources are so limited**. We could start with the artificially high cost of, say, a pair of sterile gloves. 25 years ago, when I was in school a pair cost 13.50 retail. I imagine it is at least double that or more today. How many sterile gloves are used on even one child in the NICU in an average day?

My obstretrician told me, some years ago, that, her malpractice insurance costs exceeded 600,000 dollars/yr. That meant that, before she paid herself, her enornous staff, (billing and whatnot), and her overhead, patients had to cover those costs with her fee. Now, if she would see 100 patients a week (in her office), and if she were to add in what was needed to cover the medicaid and freebies, that amounts to a lot of money per patient. I’m quite sure the amounts on everything (minus the salaries of the paid employees) have skyrocketed.

Hospitals? Yowsa. Do you realize there is a literal army of full time employees whose job it is just to do quality assurance and education? That is nonproductive work just off the top. All these things have to get paid. That is why insurance is out of reach for a sizable portion of people. It is inflated to an astronomical degree. And it is inflated, not because of “greedy doctors”, but, because certain people in the upper eschalons gain from it, both politically and financially.

Instead of looking at the problem in a mature manner, and insisting the inefficiency and corruption be addressed, we would rather sacrifice our posterity.

Let the doctors and nurses help the parent decide what is appropriate for each baby. They do this, already, but now they want to take the power of choice away from the parent.

I don’t blame any of you for this debacle, mind you. I just think society’s priorities aren’t straight. Why doesn’t anyone ever ask the health care providers for ideas when it comes to policy matters? Could it be because we have the answer the powers that be don’t want? Don;t fall for their propaganda.

Okay, I’m off my soapbox, now.