premature babies | Nuffield Council on Bioethics

Neonatal medicine

Families and healthcare professionals face difficult and highly emotional decisions about the treatment and care of extremely premature babies.

This report discusses the ethical, legal and social issues raised and proposes guidelines on giving intensive care to babies born before 26 weeks.

BBC documentary on premature babies

Last night, Adam Wishart's BBC2 documentary '23 Weeks: The Price of Life' looked at the very difficult decisions faced by parents and doctors about the care and treatment of extremely premature babies. The Nuffield Council on Bioethics considered some of these issues in its report Critical care decisions in fetal and neonatal medicine: ethical issues.

In response to the programme, Hugh Whittall, Director of the Council, said:

Neonatal medicine - Guidelines on intensive care for extremely premature babies

Decisions about whether to start intensive care in extremely premature babies

Current practice in most neonatal units in the UK is usually to resuscitate a baby if the outcome is uncertain and provide intensive care until the outlook is clearer. However, as life-saving treatments can be invasive and may cause suffering, it is difficult to know whether this is the right course of action if the baby is unlikely to benefit.

Neonatal medicine - Further recommendations

This report also makes recommendations in the following areas:

Withdrawing treatment and palliative care
Decisions during pregnancy
Avoiding the courts
Lifelong support for children who survive
Resource considerations
Data collection and information
Training

Neonatal medicine - Decision making

Parents are generally considered to have the moral authority to make decisions in their child’s best interests in all the circumstances of life, though not as if they owned them. They are often best placed to know what is in the interests of their child because they share a special bond that begins during pregnancy and develops over time.

Legally, doctors must normally have the consent of parents before giving any treatment to a child. Doctors can only override parental wishes with a court order, except in an emergency.

Neonatal medicine - Deliberately ending life

Taking intentional measures to end the life of a newborn baby is commonly regarded as a violation of the duty to protect the life of the patient. This applies even when that baby’s condition is intolerable, with no prospect of survival or improvement. The professional obligation of doctors is to preserve life where they can.

Neonatal medicine - The value of human life

The moral status of the fetus

Under English law, fetuses have no independent legal status. Once born, babies have the same rights to life as other people. This legal distinction is at odds with the teachings of many faiths and, for some, their moral intuitions.

Neonatal medicine - Best interests

The principle of ‘best interests’ is central to medical practice and UK law. It states that in all matters affecting any child his or her best interests should be the paramount consideration.

Neonatal medicine - Background: extremely premature babies

We use the term ‘borderline of viability’ to describe extremely premature babies who are born at or before 25 weeks and six days (pregnancy usually lasts for 40 weeks).

In England, 1,600 out of 584,000 (0.28%) deliveries were at the borderline of viability in the year 2004-2005. This percentage has been increasing since the beginning of the 1980s, which may be due to a several factors, including the rise in fertility treatment.

Neonatal medicine - Introduction

Major improvements in medical care mean that extremely premature and very ill babies have better chances of survival and making a good recovery. However, it can be difficult to predict whether an individual baby will have a limited lifespan and the extent to which he or she will recover from any health problems or develop disabilities. This means that families and health professionals sometimes have to make complex and emotionally demanding decisions about a baby’s treatment and care.

These decisions may be about: