2.21.2007

The Tiniest of All

Or, When It Might Be OK to Lie

The news outlets are abuzz about the report that the most premature baby ever is about to go home from the hospital. The report is interesting to me because of all the new babies born around me in the last few months, and the couple expected soon. This Guardian article is the most interesting, in my opinion. The little girl's mother was pregnant for just 5 months before having an emergency c-section- not even into her 3rd trimester. When the doctors asked how far along she was, she exaggerated by over a week, because hospital policy dictated not to resuscitate babies born before 23 weeks. Little Amillia was resuscitated, and has fought to survive until now, with a very bright prognosis for her future.

As the Guardian article points out, this brings up very serious questions regarding policies of when a baby is a baby- when does our current technology allow the new life to be kept alive? And for how long is a fetus "disposable"? Is there a line between "disposable" and "viable"? From the Guardian article (a British publication):
According to the American Association of Pediatrics, babies born at less than 23 weeks are not considered "viable". According to a landmark report published by the Nuffield Council on Bioethics late last year, which provides guidelines that all British neonatologists and paediatricians are asked to consider, babies born before 22 weeks and six days gestation should not generally be resuscitated. Below 22 weeks, no baby should be resuscitated.
...
Meanwhile, although it doesn't often happen, the Abortion Act allows terminations to be carried out until 24 weeks in Britain; any time after that there must be incontrovertible medical evidence that it would be dangerous to continue. The law in the US is predictably fraught and unclear, and in any case varies from state to state. Roe v Wade bans it after the foetus is viable, which, as Amillia has shown, is something of a contestable point.

Contestable point, indeed.

One opinion from the article:
"Should one really be trying at all to keep that baby alive?" asks Professor Richard Nicholson, editor of the Bulletin of Medical Ethics. "Chances are it will require an enormous amount to be spent on it for the rest of its life. We have much less experience of death, so we have become much less willing to accept it. In countries where infant mortality is higher it would be seen as absurd. We live in a society where we have become addicted to physical existence. It's totally unsustainable. Our attempts at the moment to keep every human physically alive as long as possible will make it less likely that the human race will survive climate change."
"Is choosing whether a baby lives or dies an economic or evolutionary one, like this professor suggests? That thought bothers me. Another expert quoted in the article, John Wyatt, a professor of neonatal paediatrics at University College London Hospitals NHS Foundation Trust, has a more compassionate view:
Most parents, when given the facts, would accept that the best thing for a baby born below 23 weeks is to allow nature to take its course, and most neonatalogists would agree that they shouldn't be resuscitated. And yet ... we need to decide what is best for each individual baby. A premature baby is as much a member of the human community as anybody else, and deserves the best care that's available. By and large this care has been extremely successful. There are thousands going into adulthood who previously wouldn't have done so."

The article appropriately ends with an essay by a mother of a premature baby.
You worry about their future, of course, and Amillia's mother will be worrying right now. You scan the pictures in the special-care baby unit of children whose lives started here, and you find yourself thinking: are they normal? Will my child be normal? But even though some of the children in the pictures don't look "normal" - they're too thin, they've got a squint, they're in a wheelchair - you don't ultimately care whether that is what is going to happen to your baby. You hope everything will turn out fine, of course you do: but you already know you love this baby anyway, and you know that nothing is going to change that. Not a doctor's grim predictions today; not a teacher's pessimistic evaluation tomorrow; not the fact that your friends' babies can do more, and earlier. You have that one, precious person - I have my Rosie, Sonja Taylor has her Amillia - and the world will be brighter and better because of it.

That's the point, isn't it? That a new precious person is in the world?

To add, another angle on the abortion discussion: the TIME story on the grassroots abortion war: crisis pregnancy centers and their strategy on winning the abortion debate one woman at a time. (I came very close to blogging about this by itself about a week ago, but didn't. Seriously, read it.)

6 comments:

mrs.burke said...

Here are some disconnected thoughts I have about this- maybe I should post them in my blog instead of in your comments, but whatever.

I have been thinking about issues of technology & human life quite a bit ever since reading "In the Absence of the Sacred" by Jerry Mander. Having a baby born at 32 weeks gestation who would almost certainly have died without lots of technology did not lessen my thinking a lot about this topic.

I agree with Mr. Mander that whenever a new technology comes along, people tend to blindly accept it based on the positive aspects without thinking about any possible negative consequences. Take a ventilator- a great thing for keeping you alive if you're in an accident and need to be kept breathing while your body heals, perhaps, but a troubling thing at the end of life when all systems are failing and you don't know when to turn it off. Or television- transmitting information to everyone quickly and instantly, at the cost of family, community, and society.

When it comes to these really, really premature babies, one question I ask is why are we in the developed world spending huge amounts of money to save these individual lives, supporting huge megacorporations that develop the technology to make it possible?

Some of these same huge corporations are exploiting the third world and contributing to economic and political instability there. And thousands of children are dying in these parts of the world, directly or indirectly because of these corporations.

Of course I wanted my child to be saved, and acted accordingly. But I think it's rather frightening how much money we'll spend on saving a first-world child, when it takes so little to save a third-world one. Why are these lives valued so differently? What is the correct way to "value" life?

Re: abortion- of course it's bad, but in those cases where it may be needed, I don't think putting an arbitrary legal number on the number of weeks of pregnancy where it would be permitted is going to fix anything. As this in the news baby demonstrated, sometimes you can save a 21-week baby. But sometimes a 28 week baby will die. My research in this area indicated that with current technology, the odds of survival go over 90% at about 30 weeks. So I was just really glad to make it that far. :-)

Joanna said...

I think you're right - I don't think this little girl's story is really all about abortion, although it does bring up interesting questions in that area. It is as you say, about technology and life. It is disappointing that a typical 'pro-life' stance doesn't actually include having a consistent ethic of life, fighting not just for life of the unborn, but life and quality of life of the poor, the elderly, the refugee, the criminal, the third-world child, etc. We have the technology to be 'pro-life' around the world, and if the same resources went into that goal that we spend at home on a few extreme cases, we could make a bigger difference.

And, yes, this story was of particular interest to me because I watched your story and knew the struggles you guys had with your baby born at 32 weeks. Can you imagine him even tinier?

beth said...

"We live in a society where we have become addicted to physical existence."

So true... death is not the end. But as a mother, you'd want everything possible to be done to save your child. That's a God-given instinct.

So much to ponder...

Brett said...

Science is a funny thing. It took nearly 2 years for my wife and I to just get pregnant. In that time, we followed several paths to scientifically "boost" our chances a pregnancy. We prayed and struggled a great deal as we attempted to reconcile our use of technology while, at the same time, we tried to recognize God's will for our lives. Ultimately, science and technology failed and it was only after we stopped turning to medicine and turned it all over to God that He blessed us with our beautiful baby boy.

What do these ramblings mean? For me, it means I cannot fathom actively deciding that a child (particularly my own), no matter the age, should be allowed to die. Secondly, it means I place a lot less faith in science than most.

As for the consistency thing, ramble on. It's easy (relatively, at least) to think consistently. That is, I can say and even believe that the lives of all people are equally priceless. That is, equally priceless in the "global, brotherhood of man" sort of sense. Can I say they all have the same value to me on a personal level? Absolutely not. No matter how much I care for the poor, the oppressed, and the third world countries, I will always care about my family more. I know that sounds cold but I firmly believe that once you start caring for everyone equally, you either a) freeze for fear of not treating everyone equally or b) detach yourself such that people become mere numbers. Do I allow my family of three to starve when I know I could feed dozens of people elsewhere for the same cost? Do I allow my sick child to die when the cost of his medicine could treat and entire village for malaria. I think those questions are answered by 1 Timothy 5:8 which says the following:

But if any provide not for his own, and specially for those of his own house, he hath denied the faith, and is worse than an infidel.

My non-expert reading of this tells me that, yes, we should care for everyone but caring for everyone falls second to caring for your immediate family. Am I wrong in reading?

Joanna said...

Brett, I think you're right in a very practical sense- we obviously have a biblical obligation to care for the people in our circle of responsibility and influence. Only when the crises close to us are taken care of can we turn our eyes to crises elsewhere.

I've thought about it, and I think the answer is not - save a hundred people in the third world rather than one baby here - but instead, do both, and waste less. I was thinking of a more systemic and attitude change, rather than a personal, black-and-white choice of one life or another. It's not likely we'll have the black-and-white choice, but our attitude will inform our shopping choices, our voting choices, our giving choices, and probably a host of others.

I'm the only person commenting on this who is not a parent, so I'm the very-least qualified. I appreciate all of your perspectives.

Joanna said...

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