Miller Geoffrey. Extreme Prematurity: Practices, Bioethics, and the Law

Cambridge University Press, 2007. - 242 p.Extreme Prematurity examines the controversial issues surrounding the clinical management of this group of neonates by the intervention of modern neonatal intensive care. The foregoing of life-sustaining treatment is of particular importance. The subject matter is very relevant because of the alarming increase in multiple and preterm births due to the increase in women who are undergoing assisted reproductive procedures and the large increase in premature labor. No recent book covers the subject in such comparable breadth. The first section of this very timely monograph covers the epidemiology and practices in different parts of the world. The second section covers bioethics considerations, including ethical theories, moral principles and quality of life issues. The third section covers national and international guidelines. The last section covers medical law aspects in the US and around the world.
For the purposes of this book, I define the extremely preterm infant (EPTI) as one who is born at less than 28 weeks’ gestation. I also include the extremely low birth weight (ELBW) infant born weighing less than 1,000g. The two are not synonymous as the latter may include infants who are small for gestational age and more mature than the former. However, the literature includes both groups, and for the purposes of argument I do the same.
Extreme prematurity is uncommon, occurring in about 1% of live births. However, the moral dilemmas that arise from intensive care for EPTIs is a continuing cause for concern. Although, for some attitudes are fixed, for many the situation is fluid. But the question remains the same. How far should those go, who care for children, to preserve life at the inevitable expense to some babies, families, and society of disability, emotional trauma, and financial cost? Furthermore, attempts to answer this question are clouded by uncertainty arising from the limitations of early prognosis, variable and changing results of management, and differing subjective judgments from health professionals, parents, guardians, and the creators and arbiters of the law. Attempts to resolve the conflict are sought from religion, bioethics and moral philosophy, sociocultural acceptance of certain behaviors, and the law, both civil and criminal. But before these can be considered, it is necessary to briefly provide some history and then document the epidemiology of EPTIs, the perceptions of those involved in their care, and the resources expended.