Friday, 11 September 2009

Just Following Orders

I don't even know how to begin reporting this revolting and outrageous story. So without further ado:

"Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday. Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early. They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment."

"Just following..." Now where have we heard that one before?

But it gets better. Listen to this nasty bit of nitpicking:

"Medics allegedly told her that they would have tried to save the baby if he had been born two days later, at 22 weeks. In fact, the medical guidelines for Health Service hospitals state that babies should not be given intensive care if they are born at less than 23 weeks."

So - two (2) days later and the doctors would have agreed that he would have had a chance of survival - even though the 'guidelines' say this is not so until a week later? If they are willing to show a latitude of 7 days, why not 9? This is simply a disgusting show of bureaucratism. You can laugh at this kind of thing if it happens at a post office where the clerk complains that your stamp slants at 2 degrees too much, but here we're talking people's lives!

There is no doctor with respect for his job and profession who makes decisions on whether to intervene or not based on arbitrary limits composed by bureaucrats. Doctors may, and very often do, decide that treating a particular patient is not feasible - but they do it by drawing on their theoretical knowledge and clinical experience and applying it to that particular individual patient in front of them! Doctors are not machines, where you insert patient data into one end and out the other pops a prescription. And any doctor who acts like he is such a machine is not fit for his profession, which is not so much a job as it is an art, as the ancients acknowledged.

And now for a bit of background knowledge on this curious 'guideline':

"Guidance limiting care of the most premature babies provoked outrage when it was published three years ago. Experts on medical ethics advised doctors not to resuscitate babies born before 23 weeks in the womb, stating that it was not in the child's 'best interests'."

We'll return to that phrase presently. Now spot the non-sequitur here:

"More than 80,000 babies are born prematurely in Britain every year, and of those some 40,000 need to be treated in intensive care. The NHS spends an estimated £1 billion a year on their care."

So bloody what? I bet the NHS spends about the same amount on wages for top-level managers and 'commissions' like the one that crafted these rules.

"Medical experts say babies born before 23 weeks are simply too under-developed to survive, and that to use aggressive treatment methods would only prolong their suffering, or inflict pain."

Except that, like so much of what 'experts' say, that's not true:

"But weeks before they were published in 2006, a child was born in the U.S. which proved a baby could survive at earlier than 22 weeks if it was given medical treatment. Amillia Taylor was born in Florida on October 24, 2006, after just 21 weeks and six days in the womb. She celebrated her second birthday last year."

And now the clincher:

"Doctors believed she was a week older and so gave her intensive care, but later admitted she would not have received treatment if they had known her true age."

Time to revise the guidelines, you might think? Oh no. Remember, there's money involved.

"However, experts say cases like Amillia Taylor's are rare, and can raise false expectations about survival rates. Studies show that only 1 per cent of babies born before 23 weeks survive, and many suffer serious disabilities."

I actually happen to think that 1 percent is not too bad. Anyway, the job of doctors is first and foremost to save lives, and this we should always try to do if at all possible. Only when it is not possible, or when intervention is arguably riskier than non-intervention, do we settle for next best, i.e. alleviate suffering. In fact, the most unsettling thing about this story is perhaps that the doctors didn't even want to do that - they allegedly wouldn't even see the baby once it was born. Because they were afraid that they would be overcome by the impulse to treat it, perhaps? Anyways, to refuse to treat anyone out of hand on the basis of purely arbitrary criteria is beneath a doctor and an insult to the people he is supposed to serve - as human beings, not as so many appliances on an assembly line.

I was made aware of this story by Matt Archbold over at CMR, who, though a little off the top sometimes, is always good for some incisive comments. Like this, referring to the 'best interests' comment in the guidelines:

"Pardon me but I get a little tired of hearing the government decide what's in the 'best interests' of people."

And further:

"Pro-choice punks are all about allowing the mother to decide if the baby's allowed to live or die until the mother actually decides she wants the baby to live. Then and only then does the government jump in and say sorry, now we actually care about what's in the best interest of the baby. Then the mother doesn't get to choose. And guess what? The government decides it's in the best interests of the baby to die."

He even goes so far as saying this proves that Western civilization has turned into a "death cult". I won't go that far, but it certainly shows that when you're a poor little foetus, there is just no way you can win in this world.

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