Premature babies have improved survival rates...

Severely premature babies: More survive being born early...but is this a good thing?The key figures from the article are:

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The data for 2006 showed that 53% of babies born between 22 and 25 weeks and admitted to intensive care lived and were sent home. The figure for 1995 was 40%.

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But of those 53% that survive...

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Yet the odds of life-long disability such as cerebral palsy, blindness or being unable to walk, has not changed, at about one in five.

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Choosing to attempt to keep a 22-25 week premature baby alive, consigns that human, should it survive, to 1 in 5 chance of serious disability. I'm sorry, but I find this horrific. In our strange desperation to keep otherwise unviable pregnancies "successful" we are deliberately increasing the number of people with serious disabilities:

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Prof Marlow said: "Because of the rise in the numbers of admissions, that actually means the numbers of children with disabilities in the population has gone up and that's really very important."

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What is wrong with us? Can we not just accept that gestation and pregnancy are not perfect, and many fetuses will not make it to a successful birth? Are our children not paying too high a price to ensure that we are comfortable with ourselves?For the record, I write this sat next to my youngest child - who was born with a serious congenital heart defect that required open heart surgery on his 6th day of life.

Hi cavediver,I'm a premie. I was born several weeks premature, with underdeveloped lungs.I'm very happy to hear that more premature babies are surviving. The value of human life is not in our ability to walk, or see. Blind people, largely, do not wish that they had never been born. And I'd take an 80% chance to be perfectly fine over death. The same statistic also means that the numbers of perfectly healthy children are increasing.If a woman wants to abort a fetus because a test shows that it carries a genetic disorder, I don't care. That's fine. But I don't see anything wrong with having a blind child, or a lame child.

Although not all blind people want to see, or deaf people want to hear, we are making amazing jumps in finding technological solutions for deafness, sight, not being able to walk ...

Hi cavediver, This gets me back to the question of when we define human life to be present. In two previous threads I put forward an argument of when we should rationally consider life -- human life -- to begin: Legal Death, Legal Life, Personhood and Abortion (now closed) and
Legal Death, Legal Life (still open for comments)

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The real question is when does this continuum of life begin to be a distinct living breathing heart thumping thinking human being. On common moral grounds, it is important to be consistent at both ends of the spectrum of life. Thus the concept of beginning needs to be consistent with current medical practice in determining when a human life has ended. This criteria has been developed over a significant period of time with a lot of ethical input from all sides into the specific ethical considerations involved.

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Legal Death

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The legal standard of death is very clear - from What is the medical definition of death? (click):

UNIFORM DETERMINATION OF DEATH ACT
1. [Determination of Death.] An individual who has sustained either
(1) irreversible cessation of circulatory and respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including the brain stem, are dead.
A determination of death must be made in accordance with accepted medical standards.

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That's the legal nuts and bolts of it: either failure of {heart\lung} system or total brain failure. Any person with either of these failures is universally and legally considered to be dead.

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The word "irreversible" is used to refer to common medical practical limits to resuscitation.

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Legal Life

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When considering this in terms of beginning rather than end, the same conditions should apply. Where the irreversible failure of either system qualified for death, the irreversible instigation of both is logically necessary for life to legally begin. Likewise "all functions" would become "any functions" of the brain. This could be reworded in a format similar to the death act above as follows:

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UNIFORM DETERMINATION OF LIFE
1. [Determination of Life.] An individual who has sustained either:
(1) irreversible instigation of circulatory and respiratory functions, and
(2) irreversible instigation of any functions of the (entire) brain, including the brain stem, is alive.
A determination of life should be made in accordance with accepted medical standards.

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Note that this is derived logically from the legal definition of {death} to the form of the legal definition of {NOT death = life}, and thus it is legally applicable and morally, culturally as acceptable as the universal definition of death.

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The heart and circulatory system develop first, followed by rudimentary activity in the brain stem, then upper brain areas, followed last by the development of the respiratory systems. Typically the limit to saving premature babies depends on the level of development of the lungs - before a certain point the lungs just cannot be made to function. This point would have to be determined by professionals in each case, based on the actual level of development the fetus has reached.

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This would in effect make the point of "uniform life" to be the earliest possible point at which assisted premature birth would be medically feasible without causing significant effect on the end result.

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(where I would define "assisted premature birth" to mean Cesarean birth in a medical facility or similar procedure/s.)The question of premature birth and disabilities was also addressed in the earlier version:

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There are also limits to how early a fetus can be removed from the womb and be kept alive by medical technology. This limit lowers steadily as technology and knowledge improve, but there appears to be a limit at which the result is less than desirable to many people.

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From Premature babies' disability risk (click)

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Just over 1,200 were born alive and 811 were admitted to a neonatal intensive care unit. Of these 314 survived to go home.

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The first phase of the study revealed at two and a half years old 50% of those studied had some form of disability.

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In a quarter of the children severe disabilities were identified, including cerebral palsy, blindness, deafness and arrested development.

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The latest results show that 40% of the surviving children had moderate to severe problems in cognitive development at the age of six, compared to 2% of a control group of their classmates.

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Bright Asamany, born at 24 weeks, is one of the most severely disabled of all the children who were born in 1995 ... his father, Kennedy, says ... if they had another baby born as early as Bright, he would say "turn off the machine, there is no need to continue".

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These premature babies, "premies," are not born fully functioning (mature) babies, they needed machines to replace functions of the natural womb to finish their development, and would have normally die without it. In one sense they are not fully "born" until they can survive off the machines, but it is normal social convention to consider them born as they have been removed from the womb (the same rational is used for the term "partial-birth abortion" although for different end purposes).

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We don't know if the 400 premies not admited died before they could be, or if their parents decided not to use the services available, as was their right (the "no heroic measures" decision also common at the end of life).

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Only 38.7% of the premies admitted to the neo-natal intensive care survived, and of those on 50% did not have significant complications\disabilities. This is a 19.4% "success" rate.

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If we can remove a fetus and keep it developing and growing with medical procedures, but the result is not a fully functioning human being -- due to mental or physical handicaps caused by the premature removal -- then I would argue that a limit has reached regardless of whether the end result is living, a limit where the result is not desirable to everyone. This point appears to have already been reached in my opinion, as only about 20% of premature births born at 24 weeks are not permanently, severely, mentally handicapped. This gets up into the area of the second standard for life, the issue of "personhood"

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And this is where I think the parents are the ones to make the decision -- based on knowledge of the risks and their personal beliefs.Enjoy.

I agree with your view, and note that large numbers of premature babies without severe disabilities have more minor problems from lowered IQ to behavioural difficulties. However, that's not the problem that I think sways it: instead, I think saving premature babies is a poor use of finite resources.

I'm not really talking about a few weeks prem here. But in any case, you're last the person I want to hear from in terms of opinion to this topic In much the way that I have practically zero interest in hearing a victim's view to the appropriate punishment for an offender. Of course - and again, largely irrelevant to my point. My sister is seriously pissed off that she's never been born! At the point of death in question here, who is this "I"? But they'd increase even more if we didn't attempt to save borderline viable prems - assuming that those (prospective) parents went on to have further children. If an early scan revealed that your prospective child was blind (say eyes have failed to develop), would you not consider an abortion?More hypothetically: you/wife/partner go for IVF treatment or similar. You have five viable embryos, but it is pointed out that three of them will be born blind should they carry to full term. You can implant one. Which one?(apologies if this is in any way sensitive to you - tell me to get lost if you'd prefer not to discuss)I would choose to abort (though I cannot speak for my wife) and I would choose to implant one of the two embryos. Does that make me an evil eugenecist? Or an obnoxious ablist? I'd like to think neither but others may disgree.If I had known at an early scan that my youngest was going to be born with his defect, I would have been tempted to propose an abortion. My opinion on this does not change in any way, despite having the most wonderful relationship with my exceptionally gifted younger son. If we had lost him during the operation, or lost the fetus that was to otherwise become him by abortion, then I may have the most wonderful daughter in his place. As it is, I will sadly never have that daughter.

Hi RAZ, But as MrJack points out, there is a very large cost involved here. Surely it is simply easier to accept a prem birth as unviable and try again? That method has been working well, in one form or another, for the past 3 billion years...

Or for the cost of one fighter plane we could cover the lifetime costs of 100 to 300 such cases.

...many of the shortfalls in the UK National Health Service, and I would put work on saving prem babies very far down on the very long list of priorities.Keeping existing humans in a good to great state of health seems far more worthwhile than trying to rescue otherwise unviable fetuses given the virtually limitless supply of viable fetuses. Edited by cavediver, : No reason given.

Unless you happen to be one of those babies.

But I don't believe there is any "you" or "I" in those babies.Even when I was a theist, I didn't believe it was fixed like that.There's a great episode of Moonlighting, where Bruce Willis who usually plays David, plays Baby Hayes, David and Maddie Hayes' unborn child, sat in Maddie's womb, chatting with his guardian angel. In order to calm Baby Hayes' anxiety about his forthcoming birth and life, the angel explains how great David and Maddie are, and how they will make wonderful parents.At the last minute, Maddie suffers a miscarriage. The angel explains to Baby Hayes that there's been a change of plan, and David and Maddie will no longer be his parents. He's actually going to be born to Bill Crosby (I think) and "don't worry, it will be great" - love it

While there may be no you before birth there is after birth, and even before birth there are parents who are you or I.Edited by jar, : appalin spallin

Eventually - "I" start to emerge over the 18 months. True. And I grieve for the children my wife and I are not bringing into being. Based on our two, they would be wondeful children, who would certainly bring something to the world. And we're choosing not to have these children. And that makes me sad because I miss them

Ah, but those other parents made different decisions.

Following an amniotic fluid test in the 22nd week of pregnancy our first child was diagnosed with trisomy 21. He had a hole in his heart and a long list of likely and potential problems. Our doctor spelled out a comprehensive network of support programs and available medical interventions including the in utero heart surgery that would be necessary.I read and read and read. I researched. I went to our local resource centre where the disabled spend time and spent some time with them. With some, I looked into their clear eyes and laughed with them as one laughs with a child. With others I looked into their clear eyes and saw a prisoner. They knew...they knew that they had the short end of the stick and that it would never get any better. Absolutely fucking horrific.After a week of gut wrenching deliberation we decided to abort the child. I determined that I might not have the courage to kill him if his misery was too great after he was born. (See the case of Robert Latimer )This fact nags at me to this day. Had I been more courageous I might have afforded him some hours or years of life. I feel like I should have made certain that the best thing was for him to die. Society does not grant me this freedom.