Croker Sack

"Democracy is the theory that the common people know what they want, and deserve to get it good and hard." — Henry Louis Mencken (1880-1956)

Sunday, March 26, 2006

Should "Bed Blockers" be left to die?

Should a society leave newborn babies to die, if the cost of their survival is higher than the majority wants to pay?

That is the question now being mulled over in the United Kingdom, according to The Sunday Times:

The Sunday Times
March 26, 2006

Doctors call premature babies ‘bed blockers’
Sarah-Kate Templeton, Medical Correspondent

PREMATURE babies who require months of expensive intensive care in neonatal units have been labelled “bed blockers” by one of Britain’s royal colleges of medicine.

The Royal College of Obstetricians and Gynaecologists (RCOG) says the huge efforts to save babies born under 25 weeks are hampering the treatment of other infants with a better chance of survival and a healthy life.

If the British change their national health system's policy and allow such premature babies to die, they would be the second European country to make such a choice:

It would shift Britain towards practice in Holland, the only European country that accepts such babies should die. One paediatrician opposing such a change described it as “involuntary euthanasia”. However, Susan Bewley, chairwoman of the ethics committee of the RCOG, said: “I would prefer that every baby could be treated, but we cannot get away from the fact resources are not endless.”

Alongside the probabilities of survival with medical attention, the costs are outlined in the article:

About 800 babies are born each year under 25 weeks. Medical advances mean about 39% of those born at 24 weeks now survive, and 17% of those at 23 weeks. A normal-term baby is born at 40 weeks.

The cost of treating very premature babies is high. A neonatal intensive care bed costs about £1,000 a day and very premature babies can require intensive care for four months.

Research to be presented at the Royal College of Paediatrics conference shows babies born at 25 weeks or under cost almost three times as much to educate by the time they reach the age of six as those born at full term — £9,500 a year compared with £3,900.

Professor Sir Alan Craft, president of the Royal College of Paediatrics, said: “Many paediatricians would be in favour of adopting the Dutch model of no active intervention for these very little babies. The vast majority of children born at this gestation who do survive have significant disabilities. There is a lifetime cost and that needs to be taken into the equation when society tries to decide whether it wants to intervene.”

Sometimes the ability to do something presents dreadful choices when that ability has both limits and high costs. (Here is a description of the limits of our abilities as manifested in survivors' disabilities.)

What price can be placed on a human life?

If it were an adult, the answer need not come entirely from society. The adult who needs medical care could answer the question when he decides what proportion of his own earnings to set aside for the costs of his care. Differences in ability (but not willingess) to provide for one's own care could be equalized by society's subsidy.

Who could answer for a prematurely born child?

There seems to be no easy answer, yet a society may not be able to afford to do everything for everyone.

For countries that have adopted "socialized medicine" as their method of paying for care, the answers must come from the majority of citizens through their government.

I wonder how the question will be answered in the U.S.A.

We already have a substantial degree of government-funded medical care for the elderly, so will that be the first group for whom the question must be answered here?


Blogger Nathan said...

This is exactly why President Bush's plea for a culture of life resonates with me. I fear the day when my life depends on some bureaucrat's decision about whether my potential contributions to society outweigh the money spent on keeping me alive.

March 28, 2006 12:41 PM  
Anonymous Anonymous said...


This stuff happens in the good ol US of A.

It's goofy to think that the result of universal health care means taking babies off life support for financial reasons. If America had health care for every American, I'm sure we would have different values than the Brits.

And nathan, your life may be in the balance one day, although it is more likely that, instead of a gov't bureaucrat, your life will depend on the spreadsheet of a Premera Blue Cross accountant or some such person.

March 29, 2006 12:34 AM  
Blogger Micajah said...

Will Kelley-Kamp,

I believe you are misunderstanding the basis of the decisions now made in the U.S.A., if you are relying on that NPR audio clip.

Here is the text of the Texas law mentioned by NPR.

Only when there is an "irreversible condition" can there be a decision to withhold life-sustaining treatment. See section 166.002(9) for the definition of an irreversible condition.

For prematurely born babies, the decision being considered in the UK has nothing to do with the existence of an irreversible condition.

For the elderly, who I think will be the first to be subject to funding decisions by the government in the U.S.A., the existence of an irreversible condition is more likely as death looms.

But, my concerns aren't centered on the decisions of doctors and patients' representatives when there are irreversible conditions. Instead, I'm concerned that we may go the way of the Dutch (and perhaps the British) and decide that it just isn't worth the cost.

I believe you are utterly wrong when you say "This stuff happens in the good ol US of A." If you think you are correct, provide an example of a decision driven primarily, if not solely, by cost considerations.

You are, of course, entitled to your opinion about the likely outcome of "universal health care" at government expense here in our country.

Until someone invents a crystal ball or other device that allows us to see into the future, we can only discuss the factors affecting such decisions and the foreseeable outcomes.

I don't have such a device, so I won't try to argue what will or will not happen here as though I knew the future.

March 29, 2006 9:52 AM  
Anonymous Anonymous said...

I don't have any examples. I see the difference now. But Americans have different values than the Dutch or the British. I don't think Americans would embrace pulling the plug on infants.

You post seemed to imply that socialized medicine = dead babies. Our partially socialized system takes care of premature babies, while poor people get care that is not as good as regular people for the duration of their lives.

Will (aka Belltowner)

March 29, 2006 11:11 PM  

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