England: Expert tells doctors: let youngest premature babies die

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BRITAIN’S top medical ethics expert has urged doctors to let the most premature babies die, with treatment offered only in exceptional cases.

Baroness Warnock believes Britain should follow Holland in setting an age limit below which babies would not routinely be resuscitated.

She says this would prevent doctors competing for the “triumph” of keeping babies alive at increasingly young ages even though they may not survive in the long term or may be left severely disabled.

Warnock’s comments were backed in part by Britain’s most senior paediatrician, who said the setting of a lower limit should be considered.

In Holland, doctors do not routinely administer intensive care to babies born before 25 weeks of pregnancy. The Nuffield Council on Bioethics, a medical think tank, is considering proposing similar guidelines in Britain. It is consulting doctors, nurses and parents about setting a 24-week limit.

Warnock, who helped frame laws on embryo research and fertility treatment, supports setting an age limit, with exceptions for babies who show they have a strong chance of living to become healthy children.

“Some doctors and nurses get competitive about the triumph of keeping these tiny, premature, babies alive,” she said. “It would be better to set a minimum age than to have no form of scrutiny or regulation. Below a certain age of gestation no baby should be kept going without very thorough scrutiny of what the prognosis for that baby is.”

Although most doctors are opposed to an age limit, Sir Alan Craft, president of the Royal College of Paediatrics and Child Health, said it was a legitimate option to consider. “One possible course of action would be not to intervene with any 23-week-old babies unless they breathe completely and spontaneously themselves,” he said.

Craft, speaking in a personal capacity, argues that, as it is not possible to tell which babies born at 23 weeks or less will survive, doctors are forced to consider resuscitating all of them, although the majority have no chance of living.

Once doctors have started assisting these babies, he says, parents find it difficult to agree to treatment being withdrawn, even though it is of no help.

The Nuffield council is investigating the costs of raising the disabled children that premature babies often become as well as the expense of intensive care in neonatal units.

A study of the most premature babies showed most went on to suffer disabilities. The EPICure study of babies born at 25 weeks or less, led by researchers at Nottingham University, found that, by the age of six, only 20% of surviving children had no disabilities; 22% had severe disabilities, including cerebral palsy; while 34% had milder problems such as a squint.

In addition, it found that only 11% of all babies born at 23 weeks survived. Since the study began, however, care has improved and the figure is believed to be closer to 20%.

Bliss, the premature baby charity, says about 50 babies born at 23 weeks survive every year and it would be wrong to deny them the chance to live.

Bonnie Green, head of external relations, said: “We would be very unhappy. It is expensive to keep adults who may not pull through in intensive care but, in their case, we do not say ‘let’s use the money for something else’.”