The official policy of the Canadian Pediatric Society is that preemies born under 23 weeks of gestation should only receive palliative care, not intensive care.
However, an American study published on May 7, 2015, in the New England Journal of Medicine revealed that nearly a quarter – 23 per cent – of babies born at 22 weeks survived if actively treated and nine per cent will not even be moderately or severely impaired.
The study looked at 24 hospitals and close to 5,000 preemies born at under 27 weeks. While almost all preemies born at 26 weeks received active treatment, or intervention meant to preserve their lives, just over a fifth of those born at 22 weeks did. Whether or not hospital staff actively treated the child played a large role in survival rates. Death is practically assured for a 22-week-old who is not intensively cared for. Nevertheless, some doctors in Canadian hospitals are refusing to intervene (provide resuscitation or life support) to save the lives of these very young infants.
A neonatologist at St. Justine Hospital in Montreal, Dr. Annie Janvier, spoke up at the annual conference of the Canadian Bioethics Society with the support of over 30 colleagues. She argued that the same case-by-case analysis employed for preemies between 23 and 25 weeks and involving doctors, counsellors, and parents should be employed for 22-week-olds.
The president of Canadian Physicians for Life, Dr. Will Johnston, explained that “the parents are the decision makers for their child. They deserve a clear discussion of the chance of survival, the likely duration of stay in the intensive care nursery, the likely impairments and disabilities attending the survival of extreme prematurity, all given without an agenda to let the child die or to pressure the parents one way or another.”
According to a May 29, 2015 article in the National Post, the head of the Canadian Pediatric Society’s fetus and newborn committee, Dr. Thierry Lacaze, said that the policy will be re-examined, but also mentioned that, “you can imagine a family caring for a severely handicapped child, they certainly cannot express in a negative way the fact they have to care for their child… but there is still a struggle, there are consequences on brothers and sisters, on the parents themselves.”
Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, wondered, “maybe we shouldn’t go here, maybe this is pushing our scientific, technical abilities beyond a point where they are of benefit to families and society and, most of all, the tiny babies.”
In 2006, the Nuffield Council on Bioethics, located in London, England, issued guidelines that are very similar to the Canadian Pediatric Society’s. They recommended that 22-week-olds be allowed to die and 24-week-olds attempted to be saved. They left the fate of 23-week-old preemies in the hands of parents and medical staff. At the time, only one per cent of those born at 22 weeks who received intensive care survived and almost all suffered from a severe disability. Since then, the survival rate of 22-week-olds has increased over 20 per cent.
