Hindu Bioethics for the Twenty-first Century

CHAPTER 5. DILEMMAS AT BIRTH

CHAPTER 5 DILEMMAS AT BIRTH SHOULD EVERY BABY BE SAVED? A medical revolution in the 1980s that assured the survival of very tiny premature babies has led to a generation of disabled children who are often retarded, handicapped, severely nearsighted, and inattentive. Most of these problems resulted because their bodies were simply too undeveloped to cope with the world outside the womb. These were the findings of a study of the Case Western Reserve University (CWRU) in Cleveland, which investigated babies born between 1982 and 1986.1 Their disabilities varied greatly. Some of these children were blind or could not walk; others were virtually normal or had only subtle learning problems. In general, though, doctors found these youngsters to be at serious disadvantage in every skill required for adequate performance in school. This is the unfortunate side of a seeming medical miracle. It is gratifying that modern technology can make ‘miracle babies’ by keeping them alive in artificial wombs. Before 1975 only 6 percent of babies with birth weights under 2 lbs. 2 ozs. managed to live. By the first half of the 1980s, the survival rate for such children had jumped 48 percent . Those odds continue to improve. Now babies weighing 2 lbs. 30 ozs. to 3 lbs. 5 ozs. have a 90 percent chance of survival. Even so, often the life for which they have been saved carries a heavy price.2 The cost is both financial and physical, raising many ethical questions. A study of care for preemies at Stanford University Hospital revealed the average cost was about $160,000. A 1990 report in the American Journal of Diseases of Children indicated that $2.6 billion is spent nationally on neonatal intensive care each year.3 Notwithstanding the high Crawford: Hindu Bioethics page 125 Crawford 113-198-226 8/21/03 11:36 AM Page 125 cost for the extraordinary treatments, half the survivors face a lifetime of disabilities cited in the CWRU study. By federal law U.S. doctors are required to commence treatment of all babies, except hopeless cases. This often develops into an ethical issue, because the very technology that can save the life of a baby dooms it to profound handicaps down the road. In such dilemmatic situations, the Hindu physician first assesses harms and benefits, and selects only those cases that will benefit by treatment. Cases are not that clear, so the physician would err on the side of life and begin treatment immediately on all viable newborns. Through periodic checks, progress is monitored, and where brain damage or the prospects of death are indicated, treatment is stopped. That decision is made after consulting with the parents of the infant. Some doctors take the position that it is their responsibility not to give a family a handicapped child. Such an attitude is not embraced by Hindu bioethics which considers that life has its own value, handicapped or not. However, the starting point of Åyurveda is to avoid premature births, and the agonizing decisions that follow by providing expectant mothers with adequate prenatal care. This means taking prenatal care programs to poor pregnant women who fail to see doctors and to mothers who use ‘crack’ or other drugs that induce prematurity. Putting together such programs will have their costs, but they will pay their way, considering the horrendous costs of neonatal intensive-care units. The State of Hawaii has saved thousands of dollars by implementing prenatal care programs. SHOULD ANIMAL TRANSPLANTS BE GIVEN TO HUMANS? After twenty-one days of battling to preserve the fragile life of Baby Fae, heart surgeon Dr. Leonard Bailey of Loma Linda University Medical Center in California announced: “Today we grieve the loss of this patient’s life. Infants with heart disease yet to be born will some day soon have the opportunity to live, thanks to the courage of this infant and her parents. We are remarkably encouraged by what we have learned from Baby Fae.”4 So ended an extraordinary experiment that had captured the attention of the world and made medical history. For three weeks the 5-lb. infant had survived with the heart of a seven-month-old female baboon. Crawford: Hindu Bioethics page 126 126 The Beginning and End of Life Crawford 113-198-226 8/21/03 11:36 AM Page 126 The heart transplant was necessary because the child was born with a fatal defect called...