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Neonatal Care at the Limits of Viability

 

            The pregnancy results are in: there is a baby on the way! Over the next 40 weeks of gestation, a future parent is filled with different emotions. There are new hopes, big dreams, and many plans for the growing family. The child begins developing rapidly in the mother's womb; each week making important strides in his or her development. All too suddenly, those hopes are destroyed and parents are filled with desperation. Preterm labor has begun around the limit of the child's viability, generally 24 weeks. Parents are frightened and doctors are filled with factual information; to make a decision based on only one opinion is unthinkable. When it comes to preterm labor at the limits of viability, the decision whether to resuscitate the infant should be a joint decision between parents and healthcare professionals. .
             In the 1973 Supreme Court case Roe v. Wade, viability was established as a fetus being "potentially able to live outside the mother's womb, albeit with artificial aid [viability] is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks" (Roe). When a child is born near the borderline of this limit, who makes the decision about neonatal care for the infant? Should it be the parents' decision? The doctors? Or should it be a mutual decision? In 2002, the American Academy of Pediatrics (AAP) Committee on the Fetus and Newborn published new guidelines that stressed that such decisions should be a decision made between parents and neonatologists (Bastek et al. 408). It also stated that parental wishes are to be respected. .
             When it comes to giving a child a chance to live, who has the right to decide if that chance will be given at all? In a recent survey of all neonatologists in New England, results showed that "a significant majority thought that the neonatologist and the parent should make the final decision together However, not nearly as many neonatologists reported that the final decision is actually made jointly" (Bastek 410).


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