Caring for Premature Babies: Cruel?

[JMJ_coder]

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.

I agree with the outrageous costs that are obscene compared to any sort of legitimate or justifiable costs associated with R&D, non-nuisance lawsuits, etc. The problem being, at 600,000 per doctor the insurance companies alone are a breed of modern robber barons.

 

[JMJ_coder]

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.

Pancreatic cancer has a 5-year survival rate of less than 5%. Liver cancer has a 5-year survival rate of just 8%. Esophagus and lung cancer aren’t much better at only 14% and 15% 5-year survival rates respectively. edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0000Jr

I’ve never heard of a single cured HIV patient, or one that hadn’t eventually (or will eventually) die of AIDS.

Treatments for both can be extremely painful. Chemotherapy and radiation treatments are torturous. I don’t imagine that the HIV drug cocktails have pleasant side effects either.

Organ transplants aren’t walks in the park, neither is open heart surgery. A person who has broken their neck, if they survive, will be severely disabled and require artificial medical equipment for life.

Should we consign these people to death because it just isn’t worth it? I think not.

 

[Ceil-1]

Really how so? I think the robbers are the ambulance-chasing lawyers.

 

[JMJ_coder]

Really how so? I think the robbers are the ambulance-chasing lawyers.

They’re both complicit. If they really wanted to, the insurance companies have enough political clout to rid the courts of nuisance lawsuits (my opinion).

 

[JMJ_coder]

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?

I reject the modern idea that all pain and suffering must be eliminated at all costs – even to the euthanizing of all those who might remind us of our own mortality.

 

[Calliso]

While not all suffering is necessarily bad I think we need to ask ourselves is there a point to the suffering. And who are we really doing a favor for here? I mean can you say that putting a 21-22 week old premie through likely tortorous procedures that will likely just mean a longer more prolonged more painfilled death is doing them a favor? Now that;s not to say that they shouldn;t be made comfortable…but I still think it could be considered cruel to pull out all the stops in cases like this.

 

[Ceil-1]

I think DO Shea is letting his/her imagination get away with itself. That is not how it works.

The main point is that people should be able to make an informed decision about their care without feeling pressured either way. Neither should a parent.

 

[dixieagle]

dixieagle;5712962:

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

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.

How very sad; what a difficult time for you. We have had to make decisions about end-of-life care for my mother and mother-in-law, and it is never easy.

 

[dixieagle]

Pancreatic cancer has a 5-year survival rate of less than 5%. Liver cancer has a 5-year survival rate of just 8%. Esophagus and lung cancer aren’t much better at only 14% and 15% 5-year survival rates respectively. edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0000Jr

I’ve never heard of a single cured HIV patient, or one that hadn’t eventually (or will eventually) die of AIDS.

Treatments for both can be extremely painful. Chemotherapy and radiation treatments are torturous. I don’t imagine that the HIV drug cocktails have pleasant side effects either.

Organ transplants aren’t walks in the park, neither is open heart surgery. A person who has broken their neck, if they survive, will be severely disabled and require artificial medical equipment for life.

Should we consign these people to death because it just isn’t worth it? I think not.

The patients suffering from the nearly hopeless cancers you describe are, generally, adults, who can make decisions for themselves as to whether difficult treatment is worth it for them. Plus, there is always the hope that there will be a breakthrough in cancer treatment, as there has been so often before (breast cancer, leukemia.) Organ transplants often result in many years of life, as does heart surgery.

None of these situations is comparable to a tiny, 21 week newborn whose organ systems simply aren’t developed enough to sustain him, no matter what measures are taken. While there may be some slow, incremental lowering of the age at which micropreemies can be saved, it won’t be much lower.

Again, careful study of Catholic teaching with regard to ordinary/extraordinary means, and some simple common sense, are in order.

 

[centurionguard]

I reject the modern idea that all pain and suffering must be eliminated at all costs – even to the euthanizing of all those who might remind us of our own mortality.

Seems to me the Truth you just stated here went over the heads of every body reading this thread.

Thanks for submitting it.

 

[s4angel]

I have had 3 children born prematurely. I am thankful that when I went into labore with two children (16 weeks and 25 weeks) that i lived in america where the doctors gave me medication to stop the contractions. When I was pregnant with my eldest I am thankful that at the time (1998) they hospitalized me when I broke my water at 30 weeks of pregnancy. My last child I am thankful that I kept the faith when my water broke at 16 and 5 days as I was being pressured to deliver a child that had zero chance of surviving the pucture healed on its own and I delivered a healthy child at 36 weeks 4 days once again they stopped the labore.I know that I was extremely lucky but I also know from the experiance of losing a child that I was not able to deal with the loss of another one (the lord knows what we are capable of ) This child lived with out help for two whole hours, He was a fighter.Why did they not at least try to stop the labore? Why when they saw him fighting for life did they not do something, anything? I understand that micropremies do not have the best of prognosis but from what I have seen those that fight from the very beginning usualy are the miracle stories.

I sat for 8 day in the NICU and I saw babies so small they would fit in one hand my child was gigantic compared to them and they were living and growing. yes there is horror stories but there is also miracles that I saw each and every day but the point is they were given a chance to live and they knew love they responded to touch and the sound of a human voice. didn’t this child deserve at least as much. didn’t his mother deserve at least as much as an attemp to stop labore?

 

[Newbie2]

The patients suffering from the nearly hopeless cancers you describe are, generally, adults, who can make decisions for themselves as to whether difficult treatment is worth it for them. Plus, there is always the hope that there will be a breakthrough in cancer treatment, as there has been so often before (breast cancer, leukemia.) Organ transplants often result in many years of life, as does heart surgery.

None of these situations is comparable to a tiny, 21 week newborn whose organ systems simply aren’t developed enough to sustain him, no matter what measures are taken. While there may be some slow, incremental lowering of the age at which micropreemies can be saved, it won’t be much lower.

Again, careful study of Catholic teaching with regard to ordinary/extraordinary means, and some simple common sense, are in order.

So the slow progress in cancer research is worth the suffering but not the progress in life support for preemies? Who says that there won’t be “breakthroughs” in preemie medicine??? Who says that organ transplants won’t someday be done on preemies??? So there is hope that “there will be a breakthrough in cancer treatment” but not a hope that there will be a breakthrough in preemie treatment??? Who says that eventually an artificial uterus system won’t be developed to allow these babies to develop outside mom when they’re prematurely born???

Cancer research comes slowly too, it’ not always in large leaps. Your comparison is flawed. Besides, how can progress be made if we simply give up or set a deadline for who’ll be treated and who will not?

I’m not saying that all preemies should be candidates for such extreme measures, but if the physicians think there is a reasonable chance for success and the parents are supportive, why not proceed?

To the OP’s point, I’ll throw out “Is it cruel to put an older baby, let’s say a full-term baby through a painful procedure such as open-heart surgery?” Would not the same moral principles apply?

 

[Ceil-1]

Children have parents who are adults and can make decisions for them. Society, as a whole, should weigh in on the side of life, stongly encouraging parents to do what they can.

But, alas, the almighty buck comes first.

There is far too much pressure, these days to to what was suggested to s4angel. This is a very disturbing trend.

 

[Mrs_Sally]

So the slow progress in cancer research is worth the suffering but not the progress in life support for preemies? Who says that there won’t be “breakthroughs” in preemie medicine??? Who says that organ transplants won’t someday be done on preemies??? So there is hope that “there will be a breakthrough in cancer treatment” but not a hope that there will be a breakthrough in preemie treatment??? Who says that eventually an artificial uterus system won’t be developed to allow these babies to develop outside mom when they’re prematurely born???

Cancer research comes slowly too, it’ not always in large leaps. Your comparison is flawed. Besides, how can progress be made if we simply give up or set a deadline for who’ll be treated and who will not?

I’m not saying that all preemies should be candidates for such extreme measures, but if the physicians think there is a reasonable chance for success and the parents are supportive, why not proceed?

To the OP’s point, I’ll throw out “Is it cruel to put an older baby, let’s say a full-term baby through a painful procedure such as open-heart surgery?” Would not the same moral principles apply?

How could we possibly do organ transplants on premies? Where are those teeny-tiny organs going to come from? I am sure some scientists would love to start creating fetuses to use as organ farms! UGH!! This would be exactly the same situation we deplore when it comes to embryonic stem cell research.

You also mention “if the physicians think there is a reasonable chance for success”. In the example cited in the OP, the drs did NOT think there was a reasonable chance of success.

Let’s do the math here. A normal pregancy lasts about nine months or 38 weeks. Full term is considered anywhere from 38 to 42 weeks of pregnancy (counting from the last menstral cycle). A 20 week old baby is barely half way through his development! Did you notice that in the article, the nurse was actually counting days – 20 weeks 5/7 etc. Each day in the mother’s womb extends a baby’s chance of survival.

One question raised earlier is whether, in this particular case, the drs attempted to stop the mother’s labor. That would be a normal first step. We don’t know, but considering that she’d had 8 (?) previous miscarriges, it may be that they simply weren’t able to.

My heart goes out to the couple in this story and I have been praying for her and other parents of premies. However, I do agree with Dixieagle that “careful study of Catholic teaching with regard to ordinary/extraordinary means, and some simple common sense, are in order.” When we demand too much in the way of extraordinary means, we open science’s floodgates to some very ugly manipulations of the human being.

 

[DOShea]

I think DO Shea is letting his/her imagination get away with itself. That is not how it works.

The main point is that people should be able to make an informed decision about their care without feeling pressured either way. Neither should a parent.

It’s “him,” which should be clear by the opening words of my first post. Think what you want, I don’t have to prove myself to you. I spent 7 years dealing with the after effects of the realities of caring for premature babies. Not just with my wife, but with many of her close friends who want nothing more than for every baby they touch to live and be healed of their many afflictions. That doesn’t seem to work out in many cases, no matter how much is spent trying, no matter the willingness of parents and medical professionals to work round the clock to make it happen. Every single baby they lose is painful to them as it is to the parents, family, etc. Medical professionals have to have a certain detachment in order to stay focused and do what needs to be done, but don’t for one second imagine that means they don’t feel, they don’t regret, they don’t suffer. They certainly do.

The care of premature, underdeveloped babies is not in any way comparable to an already developed person with a terminal illness. Making decisions not to continue care on an extremely immature baby is totally unlike dealing with end-of-life issues with the terminally ill. If you go spend some time in a NICU this would be blatantly obvious. The only similarity at all is that the same moral issues are there, but they do not present themselves in the same way.

These decisions you speak of are made. A parent in danger of delivering prematurely is first treated to try and prevent the premature birth. That isn’t a foolproof thing; despite the best efforts, a woman’s body will do what it will, it’s not up to doctors or the parents. They are informed of the realities of treatment, what it will take, and that there is no way to know ahead of time to what extent the baby’s organs will be developed. There is general guidance, but no one can be sure until it is born. They are told about the record of success (and failure), and why at 19 weeks and less it becomes impossible to keep the baby alive no matter what they do to try. As weeks of development continue, the baby’s survival can be helped my medical care, but doesn’t always work. Somewhere around the 22 week point the odds of success dramatically improve but are still no sure thing. Thus their policies as a care unit reflect those realities.

If you think “That is not how it works,” then I’d be interested to read your take on how you think it works. Why don’t you start with something simple, like 19-week and younger babies and tell me about how easy it is to keep them alive and continue their biological development?

 

[DOShea]

Children have parents who are adults and can make decisions for them. Society, as a whole, should weigh in on the side of life, stongly encouraging parents to do what they can.

But, alas, the almighty buck comes first.

The almighty buck can only buy so much. Some things cannot be done regardless of how many bucks you throw at it. You think the late Sen. Kennedy was cash strapped? As it applies to premature infants, there is an inexact point where, no matter how much you spend, the baby will not live. Double the expenditure, same results.

 

[Mary_Gail_36]

While my baby was in the NICU, I had the opportunity to reflect on ordinary and extraordinary care. I realized most of what he went through, if an adult were faced in a similar situation, would probablt considered extraordinary. For example the ventilator for a time, the agressive treatment of sepsis.

But, I am also not sure how often 21 week preemies survive the birth process. I spent literally days at a time in the NICU. I once heard the call come in for the pediatric/neonatal team to go to the labor room to attend to a 21 week baby, whose mom was in labor. I also saw the expression of sadness on the head pediatricians face.

Sadly, I never saw that baby in the NICU, so I guess she didn’t survive. But the NICU team did go to the birth. She must have received some type of care.

What I learned is that the beginining hours are the most crucial. Preemie care isn’t a straight line…it’s often 1 step forward 2 stapes back.

 

[dixieagle]

I reject the modern idea that all pain and suffering must be eliminated at all costs – even to the euthanizing of all those who might remind us of our own mortality.

If you don’t realize that there is a clear and distinct difference between following the Church’s wise teachings about ordinary and extraordinary means of care, and euthanasia, then we can’t even carry on an informed discussion.

 

[dixieagle]

Seems to me the Truth you just stated here went over the heads of every body reading this thread.

Thanks for submitting it.

Not in the least. It’s just that some posters don’t understand the difference between “ordinary” means, and euthanasia.

 

[dixieagle]

So the slow progress in cancer research is worth the suffering but not the progress in life support for preemies? Who says that there won’t be “breakthroughs” in preemie medicine??? Who says that organ transplants won’t someday be done on preemies??? So there is hope that “there will be a breakthrough in cancer treatment” but not a hope that there will be a breakthrough in preemie treatment??? Who says that eventually an artificial uterus system won’t be developed to allow these babies to develop outside mom when they’re prematurely born???

You have clearly missed my point completely. Obviously there have been enormous breakthroughs in preemie care. However, the reality is that there is a threshold beneath which even the best intentions won’t save a micropreemie whose organ systems aren’t developed enough, and have no hope of developing outside the womb (about 21-22 weeks.)

I don’t really think that, were a tiny set of infant lungs available for transplant, that it would go to a micropreemie, but rather to another infant who is more developed and with a better chance of survival (but this is all fanciful anyways.)

If you real my previous posts, you will notice that I have already alluded to a future in which some “womb-like” atmosphere may be developed that would assist these tiniest ones to developed enough to survive. There has actually been research done on this, but it has proven to be far more complicated than thought. shine.yahoo.com/channel/parenting/what-happened-to-the-artificial-womb-471959/

Cancer research comes slowly too, it’ not always in large leaps. Your comparison is flawed. Besides, how can progress be made if we simply give up or set a deadline for who’ll be treated and who will not?

Again, you miss the point. Ongoing research means that there is always hope a particular cure is around the corner. However, adult patients, at least, have the capacity to decide whether they wish to pursue often difficult treatment or not. You simply cannot compare a cancer patient, who has already-developed organ systems, with a 21 week micropreemie.

I’m not saying that all preemies should be candidates for such extreme measures, but if the physicians think there is a reasonable chance for success and the parents are supportive, why not proceed?

The point is that in the 21-22 week preemies that are the actual topic of discussion, there is NOT a reasonable chance for success. Read the posts!!!

To the OP’s point, I’ll throw out “Is it cruel to put an older baby, let’s say a full-term baby through a painful procedure such as open-heart surgery?” Would not the same moral principles apply?

Again, the difference is that the baby is older, with lungs that are developed, etc. Clearly, if there is an open-heart procedure that has a reasonable chance for success, physicians and parents will and should opt for it.

If one is going to get all in a dither, then at least be sure you understand what a poster has actually said. Also, creating fanciful straw man arguments doesn’t contribute to the discussion.