Preterm birth is risky. And, not surprisingly, the earlier a baby is born, the greater the risks. Two new studies (part of EPICure) address the survival and further development of babies born way too soon (after between 22 and 26 weeks of gestation).
The studies found that survival has increased, when comparing premature babies born in 1995 to those born in 2006. Survival rates for the first week in 2006 were 2% after 22 weeks, 19% at 23 weeks, 40% at 24 weeks, 66% at 25 weeks and 77% after 26 weeks. So far the good news. The not so good news is that the proportion of survivors affected by disabilities remains unchanged, so there’s a net increase in the number of preterm survivors that will develop, often severe, disabilities. This is the case in 45% of babies born between 22 and 23 weeks, 30% born at 24 weeks, 25% at 25 weeks and 20% at 26 weeks. (For more information, check this New Scientist article, or the references below.) This is not only a burden for the babies, but also for the parents and, apologies for sounding harsh, society.
This brings us to an ethical question: When should premature babies be allowed to die? In other words, after how many weeks is it still acceptable for doctors and/or parents to decide not to treat an extremely premature newborn? In 2006, the Nuffield Council on Bioethics in the UK recommended that babies born at or before 22 weeks should be allowed to die, while those born after 24 weeks should be helped in any way possible, those between 23 and 24 weeks should be left at the doctors’ and parents’ discretion. (The full 246 page report is here, the relevant conclusion with regards to the discussion here is at 9.16, pages 155 – 156.)
A recommendation that might sound a tad callous, but remember the numbers: babies born at or before 22 weeks are very unlikely to survive, and if they do, the probability that they will develop severe impairments is very high. This elicits a related question: When is not living better than living in pain or accompanied by severe suffering? An intuitive, emotional response, for most people I think, might be: Never. However, let’s take a step back and look at this more objectively. Not being alive and being alive are, of course, very difficult to compare, but one might say that not being alive means the absence of all the good stuff (joy, love, awe,…), but, importantly, also the absence of all the bad stuff (pain, suffering, …). Then maybe a life predominantly characterized by pain and suffering is worse than not living at all…
Yikes, gloomy topic today. Still, these topics are often quite important and impact many lives. Therefore, they merit serious consideration.
As such, kind readers, time to involve you. Below, a poll. Participation is anonymous and appreciated.
I’ll post an update on the results in a little while (say, ten days or so).
Also, I’m aware that this is a sensitive issue and that this brief consideration, due to said brevity, only touches upon the issue. It’s not meant to be an exhaustive exposition of all possible arguments. Hence, feel free to add thoughts on the topic in the comments (with respect for others of course).
Costeloe, K., Hennessy, E., Haider, S., Stacey, F., Marlow, N., & Draper, E. (2012). Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies) BMJ, 345 (3) DOI: 10.1136/bmj.e7976
Moore, T., Hennessy, E., Myles, J., Johnson, S., Draper, E., Costeloe, K., & Marlow, N. (2012). Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies BMJ, 345 (3) DOI: 10.1136/bmj.e7961