paul@phs.UUCP (Paul C. Dolber) (04/14/85)
Well, almost. From the Durham Morning Herald, Thursday, April 11, in an AP article titled "Ga. Hospital Defends Decision to Bar One-Pound Baby:" "A doctor who refused to treat a premature baby because he considered her a `living abortion' when told she weighed just one pound said Wednesday he would have accepted her had he known her actual weight was closer to two pounds... [He] refused to admit the infant Tuesday [to the neonatal unit at the Medical Center of Central Georgia] because of his policy against accepting infants weighing less than 500 grams, approximately 1.1 pounds. The girl [was] born 13 weeks prematurely... he refused to admit the infant because doctors at Peach County [the hospital in which she was born] had estimated her weight to be about one pound. When she was weighed after arriving in [the Medical College of Georgia at] Augusta, doctors found her actual weight to be 760 grams, or one and two-thirds pounds. `If that's its weight, we would have taken it,' [the doctor] said... doctors [at the Peach County hospital] were able to give only an estimate of the child's weight because they didn't want to remove the baby's blanket and life-support systems to take a more accurate reading." So, there you have it: the dividing line is not birth, but birth and a documented weight, without blankets and/or life-support equipment, in excess of 500 grams. By the way, there was a picture of the "living abortion" accompanying the article; looks pretty much like a baby to me, and about the length of the nurse's arm from elbow to fingertips. Maybe she's a small nurse, though. I'll let the above speak for itself; now, on to another issue raised in the article. The doctor said: "`If other doctors feel they can keep a child that small alive, they can have all the patients... I have no quarrel with doctors who try to keep infants that small alive, but it's my experience that I don't have anything to offer these children'... [He] said Tuesday he would not accept `babies that are living abortions' unless they are born at the Medical Center. `The chances for survival are remote, less than one in 100,' he said." Well, there may be real issues here. First, when medical services are limited -- e.g., when there are only x intensive care incubators but x + y patients who need one -- doctors must somehow choose who does and who does not receive medical services. This does not seem to apply here, though; the "living abortion" would have received treatment if she'd been born in the Medical Center of Central Georgia. Second, there is a valid medical question: Is there any instance in which "heroic measures" should not be applied? (Said question is usually asked, in pediatric cases, when the baby is born with a severe malformation.) In general, I think this is a worthwhile question; I know and very much respect one pediatrician who is distressed when some doctors try to keep some extremely malformed babies alive simply because the technology is available. Is there indeed no point whatsoever at which doctors are justified in withholding treatment? This question will, of course, become much more pressing as medical technology advances; I can imagine that one day any fetus or baby can be kept in a state legally defined as alive no matter what its condition. I'd be interested in medical opinion here, if any doctors (especially pediatricians/neonatologists) are reading this. Nonetheless, I certainly hope I never have cause to enter any hospital where I might be treated not according to how well efforts to save me were progressing, but according to a table of probabilities -- say, "He's lost 8 pints of blood, and our cut-off is 7 pints since the probability of survival after losing over 7 pints is only 0.8%." (NB: these figures are totally made up; I've quite forgetten how many pints of blood I contain, let alone how many I can do without temporarily.) Regards, Paul Dolber (...duke!phs!paul). PS: The infant was born on Tuesday; she was in "critical but stable" condition Wednesday. The doctor "said he had not received any adverse reaction to his decision." I don't know what has happened since. PPS: I really do feel sorry for doctors at times. Not long ago (a few months ago, I think), a North Carolina doctor was found guilty of, and I believe I'm recalling the phrase correctly, "wrongful birth." It seems that the doctor dissuaded a mother-to-be from having amniocentesis done despite the fact she was over 35, or something, and the baby was born with Down's syndrome with usual complications; the mother successfully argued that, if she'd had the test, she would have aborted the baby and it wouldn't have had to live. The baby -- or, if memory serves, the child -- was very much alive at the time of the trial, and one of the arguments used was that its siblings were traumatized by having a retarded sib. As I recall, the siblings even testified to that effect. Again: yes, the doctor was found guilty of "wrongful birth," and yes, a large settlement was awarded good old Mom. Life's a bitch, and then you're born.
ark@alice.UUCP (Andrew Koenig) (04/15/85)
Paul Dolber reported a recent case in which the neonatal unit of the Medical Center of Central Georga refused to accept a premature baby born elsewhere because they have a policy against admitting babies weighing less than 500 grams at birth. After quoting various parts of a newspaper article, he steps back in apparent horror to let the story "speak for itself." Paul left out a few parts of the story, though: o The part where the same doctor says that he's seen more than 3,000 cases of babies with birth weights less than 500 grams and not a single one has ever survived. o The part where the doctor says that the hospital has publicized its admission policy because it needed to do something to stop other hospitals from chartering helicopters at exorbitant cost to fly hopelessly premature babies in that had no chance of survival. o The fact that normal birth weights are about 3 kilograms. I think there's more to this story than meets the eye. If the sending hospital couldn't estimate the weight accurately, why not guess it at 550 grams? Could it be that they were trying to put some kind of political pressure on the neonatal unit to change its policy?