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Pediatrics On The Front Line's avatar

Jess, I have previously posted this, but wanted to make sure you see it. It was in response to the Archbishop’s letter. If you’ve already seen it, sorry for reposting.

I hope it provides you with more information…

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This is absolutely enraging.

Once again, a false dichotomy is presented. One which reveals how very little this prelate knows about either babies or ethics. He knows only a party line.

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Prochoice does not at all mean pro abortion.

The only ISSUE here is this: Where is the locus of control and who should make the decision?

I am Catholic.

I am also a Pediatrician who dealt with fetuses with anencephaly and many other horrible birth defects for forty years. I had to deal with extremely premature deliveries. I had to counsel couples shortly before the mom was going to deliver a baby that might be 20 weeks or 24-26 weeks. Often we wouldn't know until the baby was born. Yes, accuracy has improved. There is still much uncertainty at times.

I would help the parent(s) to understand that a 20 or 21 week baby was simply not viable. It was NOT an option to resuscitate that child - that there were very well designed guidelines from the American Academy of Pediatrics and the American College of Obstetrics and Gynecology which laid out options. Most guidelines suggest comfort care and no true intervention under the fetal age of 25 weeks. Or 23 weeks? Or 24 weeks? Even the guidelines by people who do this for a living are difficult!

I also gave the parents a very clear understanding as to WHY these guidelines existed. That a 22 week baby only weighs one pound. That the TOTAL blood volume of a 1 pound baby is 4-5 ounces.

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Let’s make things real, shall we?

— If you need to draw 3 ml (1/10 ounce) from a baby to help diagnose and treat them, and if you need to do this four times in a week to manage the baby’s medical problems, you are removing EIGHT PERCENT of the baby's total blood. For this and other reasons it’s very common for babies this tiny to require multiple transfusions simply to replace blood taken for testing.

— At that age the baby’s skin is as thin and fragile as rice paper. Simply holding the baby’s arm and pulling the wrong way can make the skin tear.

— All babies that age must be ventilated. That means that you are pushing air into a baby’s chest to breathe for it. Yes, techniques have improved markedly. BUT it is still common for them to have part of the lung surface blow out, requiring that a plastic tube be inserted between the ribs to keep the baby from dying. Sometimes they have one tube on each side.

— They can and do have bleeding into the brain.

— They can and do have life threatening infections.

— They can and do have permanent eye damage with visual impairment.

— They can and do have life-long lung damage.

30-60% of them die IN SPITE OF heroic measures by extraordinary professionals.

The estimate is that of those who survive (after about half die), half or more have severe ongoing medical problems.

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I would explain these realities to parents asking for guidance…because usually they had no information and were in crisis.

This was not to be cruel. It was to help them to have a medical imagination and to be realistic so that after having factual medical information they would know exactly what they were choosing.

I would go away to give the parents time to process. Then we would make a joint decision. It was always heartbreaking. It was almost always an urgent decision.

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I have worked in many settings. I have never once in forty years seen any medical personnel treat this process superficially, casually, or with anything but compassion. I have seen many caregivers including myself cry over the cruel choices that had to be made.

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For all these reasons, the only place that decisions about babies belong is with their parents with the guidance of their caregivers and spiritual counselors. Full stop.

The decisions absolutely do NOT belong with ignorant, ideological judges, lawyers, legislators, and/or far-away imperious bishops/priests/ministers who have zero understanding of on-the-ground medical decision making.

Accept the reality that families should make decisions about the medical care for themselves and their loved ones. Leave them alone. They are suffering as they choose, regardless of how they choose.

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Niki Mason's avatar

Jess Piper, you rank among the absolutely most awesome women.

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