What does everyone think of this

[BushyFromOz]

Excellent post vs!

[Michael]

Thank you, Eydawn.

[WelshMedic]

This is a terribly emotive subject upon which there will never be a complete consensus. I'm lucky to have two healthy children and since I've had a vasectomy, there isn't much chance that I'll have to face this decision as a parent. However, I do not think it's good medicine to treat a premature baby at 22 weeks. In my mind it can never be the right decision to put a child through unnecessary suffering when the outcome is so bleak. It's not a question of economics, it's a question of compassion. Of the very rare cases where a child has survived, then I'd also be inclined to question the gestation- mistakes happen more frequently than we realise.

WM

[Asysin2leads]

You know, I'll play the bad guy as usual here, but I have to make this point about this subject. I am going to sound like the most bitter, cynical, and possibly misguided misanthropist out there, and while I don't have the exact figures in front of me, I do know that prenatal care plays a large part in whether a child is born premature or not. This isn't to say that because your baby is born premature, you didn't take care of yourself while pregnant, but the fact of the matter is that not taking care of yourself while pregnant is a large factor in being born premature. So, as a member of the medical profession and as a fairly decent human being, I don't get all choked up about "mother's wishes" when it comes to making medical decisions for a child that will die or have horrible deficits for the rest of its life when the reason or it is the either inaction or misdeeds of the mother. Take the mother fresh out of the trailer park, who has pretty much smoked, done meth, and drank for the duration of her pregnancy, and have her say "No, you're gonna keep my baby alive, I don't care what you say to me, you do it now, here's my Medicaid card," and a part of me wants to just say "Why should we? Why should we invest so much time and effort in caring for your child when you obviously don't give a damn about him? On the off chance that we do sacrifice and work our asses off and get your baby to pull through, you're just going to raise him horribly anyway, why should we care so much when you couldn't even get a simple prescription filled while you were pregnant that would have prevented this entire mess in the first place?" Of course, I don't say that, but a part of me sure thinks it from time to time. We live in America. Being stupid and irresponsible is our God given right, its up there with owning firearms and driving monster trucks, so of course we cannot make treatment decisions based on the moral and ethical qualities of the patient or the patient's mother and father. That would be wrong. But, by God, we are the professionals here, can't we just draw one line, and say "No, we did the studying, we are the ones who work at this, this line, right here, is where your right to live your life the way you want and dictate the treatment ends and our professional opinion and feelings on what is b est for the patient begins." Isn't there any line where we can just say "No, its wrong, we're not going to do that," or will we always be bending to the will of the patient, no matter how ignorant and irrational they might be?

To answer Eydawn, the slim 1 in a million chance survivors are the ones that may make us feel good and make Reader's Digest, but unfortunately, medicine doesn't exist in a vacuum, and there has to be some balance between the resources devoted versus the odds of benefit, because there are a lot of people out there who can't even get the most basic of medical care, let alone all the machines and doctors and specialists it takes to try and give a 21 week old a very slim chance of survival. There are children right in this country who die every day because they didn't get simple, really inexpensive immunizations. You can't really take the moral highground when the $5,000 you spent in one day on an expectant preemie in the NICU could have been used to provide $10 immunizations to 500 school aged children who might just end up dying too if they aren't properly vaccinated.

We don't decide who lives or dies, but we do follow an informed course of action that is in the patient's best interest, and sometimes, as hard as it is to understand, the most beneficial thing for a patient is to pass on, whether its a 96 year old in the nursing home or a 20 week old on the ventilator, or even, heaven help us, the 16 year old laying mangled in the trauma slot after the MVA, sometimes death really is the best thing for the patient. I learned that extremely hard lesson at a very young age because I grew up on a farm with a lot of animals I helped take care of and watched die, and its still one of the hardest thing in my personal and professional life to accept, but ultimately, it is the truth.

[BushyFromOz]

Another great post........

[DwayneEMTP]

Wow Asys, what a brave, honest response.

It seems the answer to this question might be found in the way that we decide the value of human life. Having an autistic son I have given this some thought at one time or another. How do we value people? Why do we keep people alive that appear to have no realistic chance of contributing to society at any time in the future?

A man in the grocery store once asked me why my son is different (which is a kindness to people with special needs kids), after explaining autism to him he said "Man, it's too bad you didn't know before he was born." (While abortion was a possibility) Yeah...I wanted to knock him out, but if I try and view it without emotion I can see his point of view. There is an almost 100% chance by boy will not be the next president, a doctor, scientist, a leader of industry, hell, he may never even have a job. How do I define my son's value to him and explain that the world is better off because he is alive? I would gladly slaughter half the people in my town to protect him...But I'm unable to explain, scientifically, why they should be happy he is alive or make any effort to keep him that way.

How do we decide the value of the premie based simply on it being a human life, and what do we lose if we chose to devalue his/her life based on statistics?

I have no idea what the answers are. On this subject emotion is such a driving force that I pretty much remove myself from logical discussion and leave it to those of you here much smarter than I....

Have a great day all!

Dwayne

[chaser]

Wow Asys, what a brave, honest response.

Dwayne- ditto.

[Dustdevil]

Take the mother fresh out of the trailer park, who has pretty much smoked, done meth, and drank for the duration of her pregnancy...

Oh puhleeze... what do you know about trailer parks? You don't have trailer parks in New York.

Otherwise, you'd have tornadoes in New York.

[Michael]

Yes, we have no tornadoes.

[Asysin2leads]

Oh puhleeze... what do you know about trailer parks? You don't have trailer parks in New York.

Otherwise, you'd have tornadoes in New York.

You forget Dust, I didn't grow up here. Not that I grew up in a trailer park, either, but anyway, I could have said "the ghetto", but then I'd probably be accused of racism, so I decided to pick on the honkies instead. Besides, you don't necessarily need trailer parks for a tornado, only middle aged, overweight white women willing to go on camera in housecoat and curlers to talk about where they found their roofs in the morning.