Preterm Birth - Ethics

Ethics

The transformation of medical care means that extremely premature and very ill babies have better chances of survival than ever before. But it is difficult to predict which babies will die and which will live, though possibly with severe disabilities. As a consequence, families and health professionals have to make complex decisions about how much intervention is necessary or justifiable.

The most difficult decisions are about whether or not to resuscitate a premature baby and admit him or her to neonatal intensive care, or whether to withdraw intensive care and give the child palliative care.

This is discussed at great length in a report "Critical care decisions in fetal and neonatal medicine: ethical issues" produced by the London-based Nuffield Council for Bioethics.

In the UK, the debate regarding resuscitation of babies born at 23 weeks was highlighted by Dr Daphne Austin, an NHS official who advised local health authorities on how to spend their budgets in 2011. She argued that babies born at 23 weeks should not be resuscitated because their chances of surviving are so slim and that there is sufficient evidence that keeping the babies alive can do more harm than good. UK official guidelines for pre-term babies state that medics should not attempt to resuscitate babies born before 22 weeks, as they are too under developed. Babies born between 22 and 25 weeks should be given intensive care as routine.

As a result of this decision, when Sarah Capewell gave live birth to her son at 21 weeks 5 days gestation, the baby boy was denied treatment. According to the mother, he was breathing unaided, had a strong heartbeat, and was even moving his arms and legs. If he had been born two days later, they would have treated him. However, untreated, he died within two hours of birth. This took place at James Paget Hospital in Gorleston, Norfolk, in October 2008.