CPR but only after midnight
The ambiguous consequences of resuscitating (or not resuscitating) severely premature infants
I’m back from my travels! Of course, now I’m excited to share more fascinating bioethics content with you.
To begin, we have an incredibly important article about neonatal viability from The Globe and Mail. I read this article while sitting at the Lisbon International airport and I just knew I had to share it with you.
An excerpt:
If Ms. Rajendram delivered before midnight, Mount Sinai staff would ensure the twins died comfortably. If she delivered afterwards, two resuscitation teams would try to save their lives.
A doctor explained the plan to Ms. Rajendram in a way that is seared in her memory. “He said, ‘If you have the babies even a few minutes before 22 weeks, it’s going to be a death sentence for them.’”
Essentially, the article asks, since fetal gestation (the age of the neonate from the point of conception) is a rough estimate, how justified is it to withhold CPR based on this often imprecise calculation?
Here is the logic: premature infants who are born before a specific critical point in their gestational development are unlikely to survive, or may endure excruciatingly painful symptoms. As a result, it may be more ethically justified to allow them to pass away by withholding CPR. While not everyone agrees that withholding CPR is the most humane option, it’s important to remember how fragile a neonate’s body is and how CPR can do more harm than good.
Back to this critical point in gestation: it is a constantly shifting target that is influenced by numerous arbitrary factors, such where the infant is born. Is the infant born in a hospital with highly advanced and sophisticated medical technologies or not? Do they have access to the best expertise or not?
For one of the most advanced Neonatal ICUs in the world, the cut-off is 22 weeks gestation, but if you know anything about how gestational age is calculated, you know that it depends on estimates of the mother’s last menstrual cycle and/or measurements from ultrasound imaging. This estimate is not as perfectly precise as you would expect.
Think about it: if some ICUs only resuscitate neonates past 22 weeks gestation, a one-day error in estimating the day of conception can mean life or death for a neonate, couldn’t it?
This article is a must read if you are interested in beginning-of-life bioethics. The cold calculations and gray ethical dilemmas are warmed and humanized by the incredible resilient family at the heart of the story.
Thank you for your patience last week, friends! I’m looking forward to staying consistent these upcoming weeks. Soon, I will be asking you what the next steps should be for Café Bioethics; I would love your help in making it grow!
For now, I hope you have a wonderful weekend wherever you are. :)
-Nipa
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