PHL382: FINAL LECTURE, COMPROMISED NEWBORNS
NOVEMBER 21ST 2012
QUESTIONS: How aggressively should these severely compromised newborns be treated? When
should neonatologist attempt to override a parental decision to not treat a compromised newborn?
Why babies are unique...
Facts: full term pregnancy, 40 weeks, making it to 30 weeks is considered full term, prior to 30 weeks
babies can suffer several complications due to underdeveloped systems such as:
-breathing and feeding issues (no interest in eating, haven't developed yet) -bleeding in the brain
-infections/immune system deficiency
...0% survival for any pregnancy under 22 weeks
24 weeks, 50/50 survival rate (55% survival), 26 weeks (80% survival) : survival rate does not indicate
condition of life, severe complications may accompany survival
Case 1: Bella -born at 28 weeks, seemingly healthy, at one week develops serious infection, 2 treatment
resuscitation and surgery : conclusion: dead intestines and MRI reveals widespread brain damage
-will never eat orally due to intestines, will require frequent hospital admissions and will likely die in
childhood, if she does, she will be severely cognitively impaired, survival in compromised state
Case 2: Baby B, born at 24-5 weeks (50/50), 525 grams (3200g for average baby) -no breathing at
birth, breathes at 3.5 mins and continues to improve quality of breathing
options: intubate and ventilate, hope for a good outcome or palliate, death likely within 24hrs
NICU outcome data: 50% of babies under 750 grams survive with max treatment, 50% survive with
sever deficits (neurological, developmental, physical)
Q's to consider: should agressive treatment be continued for Bella or initiated for Baby B? Should
treatment for either be pursued aganist parental wish?
Neonatal decision making in Ont:
-age of consent after attaining 16, someone can act in the best interest of another if they are incapable
of expressing it for themselves
-parents need to allievate sufferings/provide medical treatment
“the single most important factor in discussions on withdrawal of treatments in the present (or
predicted absence) of severe intellectual disability”
how does intellectual ability affect our decision making?
-to have an interest in something means you have a stake in it, gain or loss associated
-subjective model of value: stake in something that matters personally. No harm after death because no
subjectivity exists therefore no interest exists, new babies have no interest due lacking subjectivity
therefore no moral obligation?, counter intuitive to think living beings don't stipulate a moral obligation alternative is an objective model: things can be good for ppl even if there are not subjectivity aware/not
-Dworkin's detached value
-Marquis 'future of value'
Intellectual disability and interest