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BABIES born prematurely at 22 weeks should not be routinely resuscitated, according to a report published yesterday that issued guidelines for parents and doctors.
The Nuffield Council on Bioethics has suggested that some extremely premature babies — whose chances of survival are low and those of disability high — should not be put through the stress and pain of intensive treatment.
Before 1980 few babies survived if they were born under 28 weeks. Medical advances have improved survival rates, but many premature babies, especially those born before 24 weeks, have physical or learning disabilities.
The new guidelines recommend that intensive care should not be given to babies born before 22 weeks, and that babies born between 22 and 23 weeks should not, in normal practice, be given intensive care unless parents make a specific request and doctors agree that treatment is possible and in the baby’s best interests.
The report, Critical Care Decisions in Fetal and Neonatal Medicine, says that at 23 to 24 weeks the view of the parents — after discussions with doctors — should have priority and that babies born at 25 weeks or later should receive intensive care unless they have an abnormality that means they are unlikely to survive.
At present there is no legal obligation on doctors to provide treatment that is contrary to their clinical judgment and that they feel would be futile.
But medical experts and campaigners expressed disquiet yesterday at the idea that treatment decisions can be based solely on gestational age.
Margaret Brazier, who chaired the committee that produced the guidelines, said: “Natural instincts are to try to save all babies, even if the chances of survival are low. However, we don’t think it is always right to put a baby through the stress and pain of invasive treatment if ... death is inevitable.”
But the report also rules out any suggestion that doctors should intentionally end the life of a critically ill baby.
Responding to the report, Tony Calland, chairman of the medical ethics committee of the British Medical Association, said that it mostly echoed “existing best practice” and BMA advice.
The Disability Rights Commission said that it was against the blanket rule on 22 weeks, while other campaigners argued that the Nuffield guidance was excessive.
Alison Davis, of the Society for the Protection of Unborn Children, and who was born with severe spina bifida, said: “The Nuffield Council seems to have decided that severe disability is a fate worse than death, and a good enough reason not to treat a premature baby.”
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