Claire Chapman
English 101
Argumentative Essay
December 9, 2015
Premature Decisions
An expecting mother goes into labor after only 24 of her expected 40 weeks of pregnancy. The tiny baby delivered is undoubtedly alive; the problem is that he is so small. A little over a pound, his organs are underdeveloped and he is having difficulty breathing among other severe complications. Despite this, he still has a heartbeat, ten fingers, ten toes, and a functioning brain. What is his course of treatment and who determines what is best for this new addition to the world? The level of aggression for treatment of premature babies born below 25 weeks of gestation should be determined by the parents of each child after being informed of all options and possible outcomes by the physician. Parental decision is critical because the point of viability for infants is always in flux, parents have the legal right to make decisions regarding their children, and both parents and physicians are willing to cooperate for the best interest of each child.
To begin, there is no arbitrary cut line for when a baby becomes viable in utero (in the womb), and therefore there should be no arbitrary cut line for when treatment is provided for a premature baby, or “preemie.” Opposition points out that the earlier a baby is born, the more likely it is to have a disability, and this is true. Particularly, babies born below 25 weeks of gestation have double the chance of having a developmental disability than that of a baby born at 25 weeks (Alexander par. 12). In addition, preemies may spend up to a year in Neonatal Intensive Care Units (NICUs), and this adds up to a significant cost. In Britain, for example, Dr. Daphne Austin, a National Health Service commissioner, speaks out that taking care of 350 babies per year in a NICU costs around ₤10 million or $10.9 million, which can be equated to over $40,000 per baby (Hall par. 7). Placing a cutoff point for not saving babies born below a certain age is to keep too small babies from suffering and also to be cost-effective.
What these statistics fail to take into account, though, is that the risks and expenses still have the possibility to pay off and yield something beautiful: a thriving human life. In 2009, admitted preemies born below 25 weeks of gestation had survival rate of 61 percent, with 48 percent not even developing a mild or severe developmental delay (Alexander par. 11, 12). Furthermore, trying to make a cutoff point based on gestational age where babies are no longer considered viable is unrealistic. Every day for a fetus is monumental in development, and just as children outside of the womb, fetuses do not all develop at exactly the same speed. Gestational age itself is not even always accurate. Gestational age is determined from the date of the mother’s last menstruation, and that allows the margin of error to be as high as an entire week or even longer (Blackwell par. 15). This means a child born at almost 22 weeks could very well be almost 23 or even 24 weeks. Dr. Kei Lui of the Royal Hospital for Women in Sydney, Australia, summarizes, “We have to get out of this concept of before midnight and after midnight, so there's a continuum. [The point of viability] is a slope..." (qtd. in Alexander par. 8). Lives should not be abandoned because of a preset determination of viability, and certainly not due to cost; life is priceless.
On a different note, parents have the legal right to make decisions regarding the best interests of their children. However, opponents point out that not all parents are fit to make rational decisions or have their children’s best interests at heart. Dr. Carole Jenny, a professor at Brown Medical School and associated with the American Academy of Pediatrics, explains that one of the chief signs of medical neglect is when a parent does not follow the physician’s advice even when “the anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over nontreatment” (Jenny par. 4). This kind of negligence can lead to unnecessary sickness or even death of a child that otherwise would end up healthy if a physician had chosen the treatment.
Fortunately, there is an effective way to combat these injustices. Laws can place temporary guardianship, and thus the ability to make medical decisions, under a person more fit to look after the well-being of the child than the current guardians; in some cases, parental rights may be fully taken away from neglectful parents. In Missouri, this law can be found in Section 475.030.4(2) of the Revised Statutes of Missouri, providing as follows: "Letters of guardianship of the person of a minor may be granted (1) where the minor has no parent living; (2) where the parents or the sole surviving parent of a minor are unwilling, unable, or adjudged unfit to assume the duties of guardianship; or (3) where the parents or the sole surviving parent have had their parental rights terminated under chapter 211.” This can ensure that neglectful parents can be stopped in order to protect the child’s rights while also allowing responsible parents to make decisions that they believe will benefit and help their child to the fullest extent.
Additionally, most parents want to be involved in ensuring that their children have the best possible chance at life, and a majority of parents and physicians are willing to work together in order to find the best route of care. Those who argue that the decision should be made solely by the physician have some valid views. They point out that most parents do not have the education or necessary knowledge to be able to make a medical decision in such a specialized area. Neonatologists (physicians specializing in the first month of life, especially in babies born early or with other complications) attend college, medical school, and then complete a three-year residency in a hospital to prepare for the job. They know the anatomy and treatment risks and may have even had a similar case from which they have learned. In short, a parent simply cannot make as informed of a decision as a neonatologist.
However, counseling between parents and physicians about a preemie’s course and level of treatment is actually encouraged by most neonatologists. A survey of 149 neonatologists in the Northeast United States showed that 77 percent believed that the decision to withhold resuscitation should be made by both physicians and parents, collaboratively. Also, discussion topics between physicians in the survey and parents are typically varied. Survey participants report that topics such as desired parental role, experience with premature and/or handicapped children, and the mother’s medical condition are often or always discussed. Large percentages of these neonatologists also discuss with parents the risks and possible outcomes of common premature complications and conditions, ranging from short-term issues like respiratory distress syndrome (a breathing disorder) or intraventricular hemorrhage (brain bleeding) to more long-term effects such as physical, intellectual, or developmental disabilities (Bastek par. 3). Dr. Tara Bastek, a doctor of Neonatal-Perinatal Medicine, conducted a study through the American Academy of Pediatrics that concluded that “neonatologists are quite consistent in discussing clinical issues...” with parents (Bastek par. 4). The bottom line is that these physicians who deal with premature infants on the border of viability every day in their jobs believe that with thorough and understandable counseling, parents are competent enough to make an informed decision about their baby’s treatment and welfare.
For babies born below 25 weeks of gestation, there are innumerable possibilities of complications that could arise and equally innumerable types of treatment available. A baby born this prematurely should have its treatment determined by its parents after counseling from the primary physician. Parental decision is necessary because there is no discernible line of viability in preemies, parents legally have authority to make decisions for their children, and physicians and parents are willing to collaborate to help each child. What is the course of action for that teeny tiny boy born at only 24 weeks? After talking with his physician, his mother decided to fight for his life and pursue treatment. He spent time in the NICU until he was ready for life outside a hospital’s walls, and now he faces the world with a heartbeat, ten fingers, ten toes, and a life that he can make anything he dreams it to be.
English 101
Argumentative Essay
December 9, 2015
Premature Decisions
An expecting mother goes into labor after only 24 of her expected 40 weeks of pregnancy. The tiny baby delivered is undoubtedly alive; the problem is that he is so small. A little over a pound, his organs are underdeveloped and he is having difficulty breathing among other severe complications. Despite this, he still has a heartbeat, ten fingers, ten toes, and a functioning brain. What is his course of treatment and who determines what is best for this new addition to the world? The level of aggression for treatment of premature babies born below 25 weeks of gestation should be determined by the parents of each child after being informed of all options and possible outcomes by the physician. Parental decision is critical because the point of viability for infants is always in flux, parents have the legal right to make decisions regarding their children, and both parents and physicians are willing to cooperate for the best interest of each child.
To begin, there is no arbitrary cut line for when a baby becomes viable in utero (in the womb), and therefore there should be no arbitrary cut line for when treatment is provided for a premature baby, or “preemie.” Opposition points out that the earlier a baby is born, the more likely it is to have a disability, and this is true. Particularly, babies born below 25 weeks of gestation have double the chance of having a developmental disability than that of a baby born at 25 weeks (Alexander par. 12). In addition, preemies may spend up to a year in Neonatal Intensive Care Units (NICUs), and this adds up to a significant cost. In Britain, for example, Dr. Daphne Austin, a National Health Service commissioner, speaks out that taking care of 350 babies per year in a NICU costs around ₤10 million or $10.9 million, which can be equated to over $40,000 per baby (Hall par. 7). Placing a cutoff point for not saving babies born below a certain age is to keep too small babies from suffering and also to be cost-effective.
What these statistics fail to take into account, though, is that the risks and expenses still have the possibility to pay off and yield something beautiful: a thriving human life. In 2009, admitted preemies born below 25 weeks of gestation had survival rate of 61 percent, with 48 percent not even developing a mild or severe developmental delay (Alexander par. 11, 12). Furthermore, trying to make a cutoff point based on gestational age where babies are no longer considered viable is unrealistic. Every day for a fetus is monumental in development, and just as children outside of the womb, fetuses do not all develop at exactly the same speed. Gestational age itself is not even always accurate. Gestational age is determined from the date of the mother’s last menstruation, and that allows the margin of error to be as high as an entire week or even longer (Blackwell par. 15). This means a child born at almost 22 weeks could very well be almost 23 or even 24 weeks. Dr. Kei Lui of the Royal Hospital for Women in Sydney, Australia, summarizes, “We have to get out of this concept of before midnight and after midnight, so there's a continuum. [The point of viability] is a slope..." (qtd. in Alexander par. 8). Lives should not be abandoned because of a preset determination of viability, and certainly not due to cost; life is priceless.
On a different note, parents have the legal right to make decisions regarding the best interests of their children. However, opponents point out that not all parents are fit to make rational decisions or have their children’s best interests at heart. Dr. Carole Jenny, a professor at Brown Medical School and associated with the American Academy of Pediatrics, explains that one of the chief signs of medical neglect is when a parent does not follow the physician’s advice even when “the anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over nontreatment” (Jenny par. 4). This kind of negligence can lead to unnecessary sickness or even death of a child that otherwise would end up healthy if a physician had chosen the treatment.
Fortunately, there is an effective way to combat these injustices. Laws can place temporary guardianship, and thus the ability to make medical decisions, under a person more fit to look after the well-being of the child than the current guardians; in some cases, parental rights may be fully taken away from neglectful parents. In Missouri, this law can be found in Section 475.030.4(2) of the Revised Statutes of Missouri, providing as follows: "Letters of guardianship of the person of a minor may be granted (1) where the minor has no parent living; (2) where the parents or the sole surviving parent of a minor are unwilling, unable, or adjudged unfit to assume the duties of guardianship; or (3) where the parents or the sole surviving parent have had their parental rights terminated under chapter 211.” This can ensure that neglectful parents can be stopped in order to protect the child’s rights while also allowing responsible parents to make decisions that they believe will benefit and help their child to the fullest extent.
Additionally, most parents want to be involved in ensuring that their children have the best possible chance at life, and a majority of parents and physicians are willing to work together in order to find the best route of care. Those who argue that the decision should be made solely by the physician have some valid views. They point out that most parents do not have the education or necessary knowledge to be able to make a medical decision in such a specialized area. Neonatologists (physicians specializing in the first month of life, especially in babies born early or with other complications) attend college, medical school, and then complete a three-year residency in a hospital to prepare for the job. They know the anatomy and treatment risks and may have even had a similar case from which they have learned. In short, a parent simply cannot make as informed of a decision as a neonatologist.
However, counseling between parents and physicians about a preemie’s course and level of treatment is actually encouraged by most neonatologists. A survey of 149 neonatologists in the Northeast United States showed that 77 percent believed that the decision to withhold resuscitation should be made by both physicians and parents, collaboratively. Also, discussion topics between physicians in the survey and parents are typically varied. Survey participants report that topics such as desired parental role, experience with premature and/or handicapped children, and the mother’s medical condition are often or always discussed. Large percentages of these neonatologists also discuss with parents the risks and possible outcomes of common premature complications and conditions, ranging from short-term issues like respiratory distress syndrome (a breathing disorder) or intraventricular hemorrhage (brain bleeding) to more long-term effects such as physical, intellectual, or developmental disabilities (Bastek par. 3). Dr. Tara Bastek, a doctor of Neonatal-Perinatal Medicine, conducted a study through the American Academy of Pediatrics that concluded that “neonatologists are quite consistent in discussing clinical issues...” with parents (Bastek par. 4). The bottom line is that these physicians who deal with premature infants on the border of viability every day in their jobs believe that with thorough and understandable counseling, parents are competent enough to make an informed decision about their baby’s treatment and welfare.
For babies born below 25 weeks of gestation, there are innumerable possibilities of complications that could arise and equally innumerable types of treatment available. A baby born this prematurely should have its treatment determined by its parents after counseling from the primary physician. Parental decision is necessary because there is no discernible line of viability in preemies, parents legally have authority to make decisions for their children, and physicians and parents are willing to collaborate to help each child. What is the course of action for that teeny tiny boy born at only 24 weeks? After talking with his physician, his mother decided to fight for his life and pursue treatment. He spent time in the NICU until he was ready for life outside a hospital’s walls, and now he faces the world with a heartbeat, ten fingers, ten toes, and a life that he can make anything he dreams it to be.
Works Cited
Alexander, Harriet. "Rethink on Baby Live -Or- Die Advice." Sunday Age (Melbourne, Australia), sec.
NEWS: 9. November 9 2014. Print.
Bastek, Tara K., et al. "Prenatal Consultation Practices At The Border Of Viability: A Regional Survey."
Pediatrics 116.2 (2005): 407-413.Academic Search Elite. Web. 3 Dec. 2015.
Blackwell, Tom, and National Post. "Survival of the Fittest ; Doctors Debate Whether to Save Tiniest of
Preemies." National Post (f/k/a The Financial Post) (Canada), sec. NEWS: A14. May 30 2015. Print.
Hall, Sarah. "Who Wants to Decide the Price of Life ?" Guardian.com March 10 2011. Print.
Jenny, Carole. "Recognizing And Responding To Medical Neglect."Pediatrics 120.6 (2007): 1385-1389.
Academic Search Elite. Web. 3 Dec. 2015.
United States of America. Missouri Revised Statutes. Section: 475.0030 Letters of Guardianship and
Conservatorship Issued, When. RSMO 475.030. Missouri General Assembly, n.d. Web. 03 Dec.
2015. <http://www.moga.mo.gov/mostatutes/stathtml/47500000301.html>.
Alexander, Harriet. "Rethink on Baby Live -Or- Die Advice." Sunday Age (Melbourne, Australia), sec.
NEWS: 9. November 9 2014. Print.
Bastek, Tara K., et al. "Prenatal Consultation Practices At The Border Of Viability: A Regional Survey."
Pediatrics 116.2 (2005): 407-413.Academic Search Elite. Web. 3 Dec. 2015.
Blackwell, Tom, and National Post. "Survival of the Fittest ; Doctors Debate Whether to Save Tiniest of
Preemies." National Post (f/k/a The Financial Post) (Canada), sec. NEWS: A14. May 30 2015. Print.
Hall, Sarah. "Who Wants to Decide the Price of Life ?" Guardian.com March 10 2011. Print.
Jenny, Carole. "Recognizing And Responding To Medical Neglect."Pediatrics 120.6 (2007): 1385-1389.
Academic Search Elite. Web. 3 Dec. 2015.
United States of America. Missouri Revised Statutes. Section: 475.0030 Letters of Guardianship and
Conservatorship Issued, When. RSMO 475.030. Missouri General Assembly, n.d. Web. 03 Dec.
2015. <http://www.moga.mo.gov/mostatutes/stathtml/47500000301.html>.