Wednesday, September 9, 2009

Baby left to die for being 'too young'

I came across this disturbing article in the 09/09 Australian written by Paul Tatnell and felt it to be so very appropriate for the times. The big push will be on now that the recess is over and many who had heard from "we the people" of our disgust with such will be voting and pressured to vote Yea rather than Nay. I encourage you to send a copy of this to your representative's and ask them if this is what they will vote for. Let them know in no uncertain terms that anyone who votes for such will be voted out come next election.

The story is indeed a sad one but it tells the story of how when the government is given the right to play God how others will suffer. Would the baby have lived? We will never know because a committee wrote the rules and played God. Man has not the right to decide who will receive treatment or not thus deciding who will live or die, only God has that right. Unfortunately those currently in power feel they have the right to make the decision and usurp the role of God. I leave you with this reminder and thought:

For from within, out of men's hearts, come evil thoughts, sexual immorality, theft, murder, adultery. Mark 7-21

Baby born after just 21 weeks and five days

Needed to be 22 weeks old to be treated

Baby died after two hours

A DEVASTATED mother claims doctors refused to treat her premature baby because it was born two days early.

The tiny boy from the UK - born 21 weeks and five days into her pregnancy - died just two hours after being born, The Daily Mail reports. ( Great link, gives full story as reported in the Mail. )

Sarah Capewell, who has suffered five miscarriages previously, said she went into early labour and was told her newborn would be dead once delivered.

But after discovering her son, Jayden, had a strong heart beat and was moving his arms and legs, she called doctors and begged them to help.

Ms Capewell said doctors refused, saying medical guidelines state that "babies born before 22 weeks are not viable and are not to be helped".

She claims doctors at James Paget Hospital in Norfolk told her that they would have tried to save the baby if he had been born two days later, at 22 weeks.

According to the Daily Mail, she told one paediatrician, "You have got to help", only for the man to respond: "No we don't."

"When I went into labour I was told he would be born dead, disabled and his skin would most likely be peeling off, in actual fact he was perfect," she wrote on her website Justice for Jayden.

"As you can see from his pic he was born alive, he was responsive and lived without help for nearly 2 hours.

"Regardless of this doctors refused to come and see him let alone consider helping him."

A hospital official said it not to blame for setting the nation's guidelines and "like other acute hospitals, we follow national guidance".

Ms Capewell is now campaigning to make the Government change the law.

"This is down to government legislation stating that babies born before 22 weeks are not viable and are not to be helped," she said.

"Now I'm asking for your help in changing legislation so other families don't have to suffer unnecessarily."

  • I am including this one comment from the many comments that were made. It sums up the situation pretty well I believe for those who would give us socialized medicine as Europe has. Ask yourself if this is really the kind of medicine you want with folks deciding that a baby was born a day or two too early to deserve to live. Makes you sick doesn't it. If it doesn't something is wrong.

Comments on this story

independant girl Posted at 1:50am today

Unfortunately, she cannot sue the hospital because the U.K. has GOVERNMENT RUN HEALTHCARE! Here in the USA we are blessed to have private health care and if we had a baby that young here in the USA we would get the care that our baby needs and given him every chance for survival! Wake up people! This is what we would have to deal with if the government runs our healthcare! SAY NO TO OBAMA CARE!


Dr. Mary Johnson said...

Dallas, I have blogged on being placed in this kind of situation back in 1998 (in Asheboro, of course):

But in 2008, the fact is that in this country/state (NC), babies less than 24 weeks or 500 grams are not considered viable and (except in unusual circumstances) would generally not be resusitated.

Saying, "NO" to resuscitating a pre-viable infant is not playing God. It's accepting cold, hard medical facts, and setting reasonable limits that actually help doctors make responsible decisions.

At this stage in development, just a few days in gestational age (assuming it is accurate) can make a tremendous difference in outcome. I don't know anyone (myself included) that would have resusitated the baby in this story (if the dates were indeed close to being correct).

Moreover, location is everything. This baby would most likely not have had a decent chance even in a tertiary center with a NICU. When it comes to smaller hospitals, most general Pediatricians are not comfortable resusitating these extremely premature infants.

Oftentimes these tiny uber-premies (below 23 weeks) do have strong heartbeats, move about, and have some respiratory effort when they are born. They can live for several hours without intervention. It's heart-breaking. And the parents almost always want you to do something.

But please take it from me, if you do intervene, the treatment inflicts great pain and can be tantamount to torture.

It is honestly more humane to let them pass in their Mother's arms.

Now ten years ago, before we had the research to set guidelines, the decisions were more individualized (as they might have been in this case - where a woman had had multiple miscarriages), and babies at 22 and 23 weeks were resuscitated.

But with very rare exceptions, these children had a dismal prognosis and usually died or had horrific sequelae and nothing approaching a normal life - even after extensive/tremendously expensive intervention.

I feel very sorry for this young Mother, but I honestly think she is misguided in her efforts to force intervention in such cases.

That's what I think, for what it's worth.

Jeff Dreibus said...


So which will it be?

Obamacare with which bureaucrats may unaccountably allow people die for being too young or too old?

Or "tort reform" which is touted as the "only" effective means of "cost control" for the existing privatized health care industry -- and which will allow them to operate even more negligently without any fear of repercussion whatsoever? In my experience, that sounds pretty much like the way they operate already.

Wow, some "choice" . . .

Jeff Dreibus

Ticker said...

Doc, I will have to take exception. The doctors in this case made no decision, it was made by a committee which gave them an out, an excuse to set aside a sacred oath.

My great grandson was resuscitated at 22 weeks and lived for a month. Unfortunately Baby Augie was hydrocephalic which lowered his survival chances but at least the doctors made an attempt. Those few weeks changed the lives of many family members for the better. God decided when Augie was to die, not man and that is the way it should be.

Cold medical facts be damned when it comes to saving a life. Does "Do no harm" ever enter these folks mind? How can they know the child would not live? Statistics? Numbers lie as we all know.
The child was a living breathing human being and the doctors forgot their oath. If they had tried and the baby had died at least the mother could have found peace in that.

Oh and I do know a bit about playing God, or so I thought I was being placed in a position to do such, in life saving situations. I have been absolved in that situation and know I did my best. The doctors in this case didn't.

That's my opinion for what it's worth.

Dr. Mary Johnson said...

And Ticker, very respectfully and with deference to Augie, I must take exception right back.

In this day and legal environment, doctors MUST have guidelines & protocols that they can fall back on when they make a judgement call. Medical protocols are born of statistics & studies.

Physicians have been sued for "wrongful birth/life".

Arguably, God makes His decision when the baby is born too early. It's we humans (especially adult ones) that muddle things up.

Also arguably, when a physician resuscitates an infant that he/she knows has little or no chance for long-term survival - that is doing harm to the infant - and is morally wrong and even cruel.

"First Do No Harm" is sometimes a hard thing to navigate.

GM Roper said...

I'll have to side with Ticker Dr. Johnson. It is damnably difficult to state the date of conception as you well know and the baby in Tickers story missed by two days? How on earth did the Docs know that it was two days early.... maybe it was 5 days over.

My grandson was born with a severe problem with his blood sugars that dropped precipitously after each meal. He spent 18 days in intensive care and I'd hate to think that some damned bureaucrat could have had a hand in saying "Nope, too expensive," because he is healthy and 9 months old now.

Dr. Mary Johnson said...

GM, yes, gestational age can be difficult to gage sometimes. I suspect, however, that this woman, with a history of several miscarriages, was getting good prenatal care and her dates were accurate (you are essentially dating from the last period).

On the flip side, this child could have also been much younger than its stated age. Consider what you are advocating then. It's hard to tell from the pictures that are posted, but the baby does not appear viable.

It's NOT only about "cost" or
"some damned bureaucrat" (although arguably that's what this Mother is advocating - some "damned bureacrat" spitting the the face of conventional medical wisdom and forcing a doctors' hands in a situation where it should not be forced).

I am just as opposed to Obamacare as you are. But the arguments have to be reasonable. The world of uber-extreme premies - where NOTHING is black and white - is not the place to set up camp with your arguments.

We don't live in Nazi Germany, we're not going to live there anytime soon if you or I have anything to say about it, and no one is going to let a baby go because its blood sugars are unstable and you know that.

I've gone back and read the story. Here in the states, we stop or slow labor all the time. That part of this woman's story is fuzzy. Perhaps she was too far gone in labor to stop it.

Again, if this woman had been laboring in a small-town hospital here, she would not have even been a candidate for transport to a tertiary care facility (before delivery) - until the baby was 24 weeks gestation.

At that point, the decision to resuscitate is left to the small town doctors/hospital/staff - and legally/ethically they MUST have guidelines/protocols upon which to fall back on.

In this case (21 weeks), the OB would not even call the Pediatrician - it would be managed as a miscarriage.

Ticker said...

Doc, the point is that in GB it is a government policy which determines life or death. Under Obamanocare it will be the same. Is that what is needed in this country?
I will have to assume that the decision not to give treatment to babies under 24 weeks is something that doctors and their board of "ethics" (and I would use that term loosely in such cases as this)came up with the decision or policy. I would ask if it is written or unwritten in the medical Holy Grail? I would also have to suppose that at this point it is not a government policy as is found in GB and most of the countries which have to cut cost in someway to sustain a unsustainable socialist health care program.
When we arrive at that point in this country we will have slipped into the deepest pit of disregard for human life ever seen in this country. We have already overstepped the moral bounds in so many ways that this would just be another step into the deepest abyss of moral degradation. May God have mercy on our souls if we allow this to happen.

Dr. Mary Johnson said...

Ticker, we are NOT talking about a callous disregard for human life here.

We're talking about reasonable guidelines for intervention based on medical facts and proven limits to viability.

Fifteen years ago, I resuscitated 22 and 23 weekers on a psuedo-regular basis. I'm quite good at the technical aspect of it - as doing it more-or-less by myself in one podunk setting or another has made me good at it. But at some point you have to think about what you are doing and why.

There is a point at which intervention becomes an ego-feeding, cruel experiment.

I saw some horrible outcomes for these uber-premies in the NICU (indeed, one of the reasons I am not a Neonatologist is because I could not stomach what was being done to some of these babies - for the sake of a "life" that amounted to nothing but unimaginable pain).

The very article you cite indicates that in that time, very few advances/gains have been made in pushing the viability limit.

Again, as in ANY other aspect of medicine, there have to be reasonable, research-based guidelines and protocols for doctors making these hard judgment calls to fall back on. In the UK, this has been done by the government.

I daresay most hospitals in this country have guidelines for intervention (as a legal protection) - and we don't need government intervention to carve anything in stone. Keeping the government out of the equation provides leeway for individual decisions based on shades of grey. But having some kind of protocol also gives doctors something upon which to hang a hat.

I would also submit that when doctors have to make these hard calls - based on their training, experience, comfort level, and resources, they should not be called "murderers" . . . or have their character assaulted.

Ticker said...

Doc,For doctors to have leeway in the decision is a good thing. ONCE AGAIN the point WAS and IS we do not need the government making the decisions or setting the rules for doctors in this country.

No one is calling doctors murders, at least not in this country and of this date but I would certainly call the government(of GB) worse in this case since they were the ones who left no room for discretion by the doctor.

Dr. Mary Johnson said...

And in this particular case, P, it sounds like the doctors were in agreement with government policy - they did not feel compelled to intervene.

Ticker said...

"it sounds like the doctors were in agreement with government policy - they did not feel compelled to intervene."

Ain't government playing God wonderful?

Dr. Mary Johnson said...

Ticker, it's like you are ignoring every argument I've offered here.

I love you dearly, but I am beyond exasperated. Pediatrics is what I do for a living. I have some small experience in these kinds of situations (never easy) and some expertise in this area.

And I am telling you that this decision was reasonable and even compassionate - and NOT about playing God. It's about accepting our human limitations and letting life/death take its course.

I don't know what else to say.

Ticker said...

When the government can overrule the judgment of a doctor, then the government is playing God. Again that is the point being made here. It is about the government dictating rather than allowing individual judgement.

In this case as in many cases I will have to respectfully say that the doctors may use "their" better judgment but I stress that it is "their judgment" based on what ever they have experienced.

I depend upon a higher authority who said:

Jeremiah 1:5
"Before I formed you in the womb I knew you, before you were born I set you apart....

Knowing this I can make no judgment call on who is to live and who is to die be they in the womb or a new born. I can not judge that the child would be worse off if it lived. Just as Augie lived , even for the short time, much was accomplished through his short life. I would have to ask if things would have changed as they did if the doctor had chosen to allow Augie to die rather than putting forth the effort to sustain life. Augie had a purpose for being born and once the purpose had been fulfilled he died. Had there been a governmental policy on the subject in the US Augie would have just been allowed to die and his purpose would not have resulted.

As Ecclesiastes 3 states so beautifully, there is a time for everything:

1 There is a time for everything,
and a season for every activity under heaven:

2 a time to be born and a time to die,
a time to plant and a time to uproot,

3 a time to kill and a time to heal,
a time to tear down and a time to build,

4 a time to weep and a time to laugh,
a time to mourn and a time to dance,

5 a time to scatter stones and a time to gather them,
a time to embrace and a time to refrain,

6 a time to search and a time to give up,
a time to keep and a time to throw away,

7 a time to tear and a time to mend,
a time to be silent and a time to speak,

8 a time to love and a time to hate,
a time for war and a time for peace.

9 What does the worker gain from his toil? 10 I have seen the burden God has laid on men. 11 He has made everything beautiful in its time. He has also set eternity in the hearts of men; yet they cannot fathom what God has done from beginning to end. 12 I know that there is nothing better for men than to be happy and do good while they live. 13 That everyone may eat and drink, and find satisfaction in all his toil—this is the gift of God. 14 I know that everything God does will endure forever; nothing can be added to it and nothing taken from it. God does it so that men will revere him.

15 Whatever is has already been,
and what will be has been before;
and God will call the past to account.

I can add no more to that other than AMEN!

Anonymous said...

Dr. Mary Johnson, I too am a pediatrician. A fairly recent graduate of residency who works with a neonatologist turned private practioner who is regularly surprised at the healthy 25-weekers that come to our clinic for well-child check ups. When my colleague finished her fellowship, they did not resuscitate below 27 weeks gestation. Who was the one who decided to try? And how did it come to be that many 25 weekers survive without ROP and IVH? If Obama-care policy follows UK policy, and this had been in place since my colleage finished her fellowship, medical innovation would not have been allowed to proceed. Unfortunately, viability is not defined in Webster's, and like Schrodinger's cat, you really never know where it is or what its status is.

Dr. Mary Johnson said...

I'm not recently-trained. But I'd bet real money that I've seen and done more in this realm - especially in the sticks - than you have.

If you are a Pediatrician, then you know that there are many varibles that factor into the equation of making the decision to resuscitate (including relative certainty about gestational age - i.e. is a 22 weeker actually a 22 weeker?). That's where judgement calls come in. And doctors can always defy "the rules" to make them.

Indeed, I am someone who got fired for making a judgment call that saved an infant's (not a premie's) life.

If you are a Pediatrician, then you know that there have been a great deal of advances since your colleage trained (if she did not resusitate babies less than 27 weeks, she is considerably older than I am).

If you are a Pediatrician, then you know that for a while, Neonatologists did things just to push the limit - to see how far they could go. It's the reason I am not a Neonatologist - because I come from the training era where this was going on (a time of great "innovation") and I saw a lot of horrible things. In several cases I was part of it - because no one knew how to say, "NO".

I repeat: Horrible, horrible things. They weigh heavily upon my soul to this day.

If you are a Pediatrician, then you know that the research that's been done on the outcomes of these mega-premies (from the era of "innovation" when all limits were pushed) does not support resuscitating babies less than 23 weeks. And 23-24 weeks is a grey area where judgement calls are often made - depending on what the infant looks like and does when it is born.

These babies generally (not always - it's medicine and there are ALWAYS exceptions) die anyway. Or they have awful/life-long sequelae. Should we inflict every manner of torture upon ALL of these infants - for weeks or more - just to make the family feel better?

Think about what you are saying. This young/grieving Mother wants the state to make it MANDATORY for doctors to resuscitate babies they don't think are viable (not defined in Websters - but hey, we went to school for a decade or longer in order to be able to make those calls). Does "First do no harm" ring a bell?

There are simply limits to what we can do. It is human hubris to think otherwise.

If you are a Pediatrician, then you are aware of the cloud of litigation under which we all practice - especially in the USA. I suppose, since they do not happen often, it might be easy to shrug off a "wrongful life" lawsuit - unless it's happening to you.

In the article, Ticker cites, with all of these things in mind, the state (consulting Neonatal experts) set limits to make it easier for doctors to say, "NO, we are not going to put this child through this."

And in THIS case we are not talking about a 25 weeker (which I or anyone else would resuscitate). We are talking about a 22 weeker.

I would also point out that (although I in no way support it), babies over 22 weeks are aborted in the USA and it's totally legal.

This area of medicine is NOT the place to hang you hat when opposing Obamacare.

And let's be clear I oppose Obamacare.

There are other battlefields.