Ethical Legal Discussion Board

The issue that I chose to discuss is something my womens health teacher

discussed in class a few weeks ago, as well as being briefly mentioned in the Refusing,
Withdrawing, Withholding Treatments and Life Support lecture for this class. The issue
is whether to withdraw or withhold treatment from premature infants that are born alive,
but considered too weak or underdeveloped to live for very long, or if they survived are
considered to have very low prospects for a good quality of life. According to Haward,
Kirshenbaum, and Campbells (2011) article, international guidelines allow the parents to
decide at 23 and 24 weeks gestation if they want their child to receive resuscitation or
medical treatment after birth. Only the United States, Germany, Canada, and United
Kingdom initiate resuscitation or treatment in the intensive care of infants at 22 weeks
gestation if the parents demand treatment for their children, otherwise they are only given
compassionate care (Haward, 2011). Compassionate care, or phrased and defined in
Rochmans (2011) article as comfort care includes being swaddled and given to the
parents with no medical treatments offered.
In Rochmans (2011) article, she tells the story of a 21 week and 5 day gestation
infant that was born in a German hospital and survived. Although this infant beat the
odds and survived, most children born this prematurely do not. According to Haward
(2011), 95 percent of infants born at 22 weeks do not survive long enough to be
discharged from the hospital. Another article by Allen and Levy (2009) told the story of a
woman who gave birth to her daughter at 21 weeks and 5 days gestation, but in this case
the doctors refused to treat her daughter. The doctors stated that the hospital does not
provide medical treatment for infants born under 22 weeks gestation. The womans
daughter survived for two hours in her arms before passing away (Allen, 2009).
Treatments are withheld from extremely low birth weight preterm infants because
they are not expected to survive or, if they do survive, have a high risk of developing a
disability that could affect their quality of life. However, if an infant survived at 21 weeks
and 5 days, even if it was not likely, shouldnt we give the babies under 22 weeks a
fighting chance at life instead of leaving them to die? Even though there is a 95 percent
chance that they will not survive, there is a 5% chance that they will and I believe that
these children should have to opportunity to survive. Bringing up the debate about the
quality of life the infants will have if they do survive, in Hawards (2011) article, studies
show that as the preterm infants get older and are able to comment on how they believe
their life has been they, along with their parents, responded with higher-than anticipated
overall quality of life perceptions. When the infants are born, in the neonatal intensive
care unit (NICU), and struggling to stay alive there is no way to predict how they will
perceive their lives in the future. We can make predications on what disabilities they may
have, but we cannot predict the degree to which these disabilities they will affect their
lives.
In the Refusing, Withdrawing, Withholding Treatments and Life Support lecture
for this class we talked about the Baby Doe Amendment in 1984 that considered
withholding nutrition, fluids, and medical treatment as child abuse with regards to
disabled children. If this is considered child abuse, why is it acceptable to withhold
nutrition, fluids, and medical treatment from a premature infant that does not even have a
disability yet, only has the possibility of developing a disability?
According to Guido (2014), beneficence is the basic obligation to assist others
or promote good. I believe that we are not promoting good by allowing these children
to die without giving them a fighting chance. If we do everything in our power to provide
them with life and they still do not survive then at least we know we did everything we
could. If they do survive, we know it was because of our interventions and support that
allowed this child to live. I believe care should not be withdrawn or withheld from any
extremely low birth weight preterm infant that is born alive.
















References
Allen, V., & Levy, A. (2009) Doctors told me it was against the rules to save my
premature baby. Mail Online. Retrieved from
http://www.dailymail.co.uk/news/article-1211950/Premature-baby-left-die-
doctors-mother-gives-birth-just-days-22-week-care-limit.html
Guido, G. W. (2014) Legal and ethical issues in nursing (6
th
ed.). Upper Saddle River,
NJ: Pearson.
Haward, M. F., Kirshenbaum, N. W., & Campbell, D. E. (2011). Care at the edge of
viability: Medical and ethical issues. Clinics in Perinatology, 38(3). Retrieved
from http://www.mdconsult.com.ezproxy.lib.usf.edu/das/article/body/438619058-
2/jorg=journal&source=&sp=24544577&sid=0/N/919106/1.html?issn=00955108
&_returnURL=http%3A//linkinghub.elsevier.com/retrieve/pii/S00955108110005
58%3Fshowall%3Dtrue
Rochman, B. (2011). A 21-week-old baby survives and doctors ask, how young is too
young to save. Time: Health and Family. Retrieved from
http://healthland.time.com/2011/05/27/baby-born-at-21-weeks-survives-how-
young-is-too-young-to-save/