Tough Calls

How does one make such a decision?

Oct 22, 2007

Weigh options when saving premature baby

I REFER to the article, 'Saving tiny tickers' (ST, Oct 11).

It is indeed heartening that medical advances allow the babies mentioned to enjoy a new lease of life.

Infant mortality has been reduced drastically because of the excellent medical care and services provided by Singapore's health-care workers.

However, we should not use the plain vanilla number of initial infant survivals as the basis of a job well done by health-care professionals.

This holds true, especially for extremely premature babies.

With advances in medical treatment, younger and younger 'premmies' are able to survive.

However, some will have disabilities, from minor to major, because of their early arrival and subsequent damage to their brain and under-developed organs.

If a baby is severely brain-damaged, where his quality of life in future is likely to be almost non-existent, should the doctor go all out to save the baby, just so he is alive for another painful day?

Or should the doctor let the baby die with dignity, through compassionate inaction?

Who should be the one to make such an important judgment call on the treatment (intensive, moderate and just enough to prolong the life, letting go) for the tiny patient?

For parents, this dilemma can be very much be like that of the relatives of a brain-dead patient.

It is therefore important that a clear standard set of rules and guiding principles be provided and adopted for extreme premmies' treatment, as this is a sensitive and grey area where emotions, and personal and religious morals and convictions play a big part.

It is important that the parents have a say in the premmie's treatment and can make informed decisions.

This is because, as parents, their decisions will be based on what is best for the baby.

Doctors should not be biased against their young patients' parents, even when the parents' views and opinions differ greatly from theirs.

Doctors should also respect parents' decision on treatments offered to the baby, even if they disagree with the parents' decision.

At the end of the day, it is the parents, not the doctors, who will have to care for the disabled child.

Thus, treatment options should be scaled towards what the informed parents want.



As a resident working in the NICU, I grappled with such dilemnae almost daily. Why save the premature, especially the severely premature, when the child eventually develops disabling conditions like cerebral palsy, bronchopulmonary dysplasia, ROP, all requiring long term medical care, with questionable quality of life. And the caregivers, having had to deal with the heartbreaking situation, are now saddled with a huge hospital bill, & look forward to a life time of probably repeated hospital stays & visits & seeing their child suffer.

But as a resident, one sworn to save lives, we pretty much did our damnedest to save even the most premature of babies until we knew that there was nothing much else we could do for him. I don't remember any one of the parents trying to stop us from doing so. I sometimes wondered why.

But then I became a parent. I then realized that the love one has for one's child, even unborn, is undescribably all-encompassing. I understand now, why these parents would want the doctors to try their damnedest, no matter how disabled or how much suffering their child might end up with. In a way, it's a selfish kind of love.

In any case, it's a tough call to make. To save or not to save. You tell me.