God. Real. Right.

Here’s the Baptist Press story I mentioned on the air yesterday.

In U.K., care denied for premature baby

Posted on Sep 18, 2009 | by Staff
WASHINGTON (BP)–A young British mother says her prematurely born son was left to die last October by doctors because he fell two days short of the minimum requirement for care.

Sarah Capewell’s son, Jayden, was born 21 weeks and five days into her pregnancy, but physicians said he needed to be at 22 weeks gestation in order to be treated, she told The Daily Mail in a Sept. 9 article. He lived for nearly two hours without medical assistance. She is seeking a review of the guidelines followed by National Health Service (NHS) hospitals in such cases.

Jayden, who was born at an NHS hospital in Norfolk, was breathing without help, had a strong heart rate and was moving his arms and legs after his birth, said Capewell, 23.

She told The Daily Mail she pleaded with a pediatrician, saying, “You have got to help.” The doctor said, “No we don’t”

While she was having contractions, a chaplain visited her to make plans for a funeral for her yet-to-be-born son, Capewell said. “I was sitting there, reading this leaflet about planning a funeral and thinking, this is my baby, he isn’t even born yet, let alone dead,” she said, according to the newspaper.

Compiled by Baptist Press Washington bureau chief Tom Strode.

Here’s the well-informed listener e-mail I received in response to what I said on air:

I enjoy listening to your show almost daily as I drive home from work and I appreicate the topics you discuss. I generally agree with most of what you say. However on this subject from Oct 6, 2009, I think you were not well informed and I found myself in sharp disagreement with your statements. The lady in the UK unfortunately gave premature birth to a baby that was 21 and 5/7 weeks. You point out that the UK social medicine does not cover babies less than 22 weeks and made the point that the dates could have been off by a couple days. While I appreciate your larger point of the intrusion of government/ insurance/ agencies between a doctor and patient, this story was a very poor choice to use. I am a neonatologist and on a very regular basis I am confronted with situations like this one. As a Christian, I struggle with the questions of when it is appropriate to treat and take damaging invasive treatments and when it is right to provide comfort care for these babies on the edge of viability. This situation, however, would have been no struggle at all. The NRP (Neonatal Resuscitation Program) defines the edge of viability as 23 – 25 weeks. Older than that and every neonatologist would resuscitate and undertake interventions to try to keep the baby alive. Below that, no ethical neonatologist would offer a resuscitation. Those babies born before 23 weeks simply cannot survive under our current therapies and technology. Between 23 and 25 weeks requires clinical judgement and consultation with the family to decide on the best course and therapy for the baby or none at all, because even with the highest levels of intervention, less that half of those babies survive. Your point that the baby was off by just 2 days is just not true. I do not know the law or health system in the UK, but I suspect that the cut off of 22 weeks (a week earlier than actual survivability) is to allow the physicians to judge if a baby dated earlier may in fact be older and decide to intervene and provide life sustaining treatments.
I would have done exactly the same thing in the same situation as the doctors did in the UK. For you to call the situation “disgusting” (or was it “disturbing”?) is at some level calling what I do disgusting. It is not disgusting to offer compassionate care to a premature baby that has no chance for survival instead of painful and extremely invasive care that will not change the ultimate outcome. Make all the points you can about government run health care and I’m right with you, but get your facts straight about the stories you use to illustrate your point.
Sincerely,
Nathan _______, MD, PhD

And here is the reply I sent to that e-mail:

Nathan,
Thanks for the information. Obviously I am not a medical doctor and I try hard never to pretend to be one! Your point is well made. I will probably make time at the beginning of the show tonight to mention it.

I was careful, however, on the air, to say that I am not in favor of throwing all scarce resources at every life regardless of viability, and that my concern is not that this baby could or could not have survived, but that a government bureaucracy will be no different than an insurance bureaucracy in defining standards based not on the needs of individual patients but on the bottom line and statistical norms. I don’t believe the bottom line and statistical norms are evil bases for decision. But they do create a conflict of interest when the level of care provided for an individual patient is decided (not just influenced) by the organization with a financial interest in not treating the patient, rather than by the caregiver and family of the patient. Obviously, the caregiver and family also can ignore neither the scarcity of resources (and hence expense of care) nor the genuineness and extent of the benefit of care. But the conflict so often criticized in our culture between the insurance company’s profit and the patient’s needs is not aided one tiny bit by the government’s control.

I don’t think I made my point clear at all, so I appreciate both the technical knowledge you share here and the opportunity to make my point clearer.
Take care, and feel free to correct me any time you’d like!
bkc

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This entry was posted on Wednesday, October 7th, 2009 at 9:00 am and is filed under Culture. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.