bpas responds to Nuffield Council on Bioethics’ report on preterm babies

‘Ethical comment on the care of preterm babies is welcome - but it does not shed any new light on abortion’, said Ann Furedi, Chief Executive of bpas.

Babies born at or before 22 weeks should not be resuscitated or given intensive care, a report by the Nuffield Council on Bioethics, which considers ethical questions raised by advances in medical research, says. For those born after 23 weeks, the recommendation is that doctors should review the situation with the parents and take their wishes into account. But doctors warned no two babies born at 22 or 23 weeks would be the same.

The report has been released after two years of research. It also gives guidance on how parents should resolve arguments with doctors over the fate of their babies. The report comes against a backdrop of medical advances which have been able to sustain the lives of very premature babies. However, research shows that many of these babies do not live very long, or go on to develop severe disability. Part of the problem is that despite advances in modern medicine, it is not always obvious to doctors which babies will survive and thrive.

Professor Margaret Brazier, who chaired the committee that produced the guidelines, said: ‘Natural instincts are to try to save all babies, even if the baby’s 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 the baby is unlikely to get any better and death is inevitable.’

The inquiry also looked at longer-term support for families, and resource implications for the NHS. But it rejected suggestions that active steps be taken to end life - so-called baby euthanasia - in certain circumstances.

Dr Tony Calland, chairman of the medical ethics committee of the British Medical Association (BMA), said much of the report echoed ‘existing best practice’. But he added: ‘The BMA believes that blanket rules do not help individual parents or their very premature babies. Each case should be considered on its merits and its own context. While we believe that not all patients, including babies, benefit from medical intervention if survival is unlikely, it is important that each patient’s circumstances are assessed independently. We therefore cannot agree with stringent cut-off points for treatment.’

Ann Furedi, Chief Executive of bpas, said:

‘This report is welcome in giving clear ethical guidance for doctors working with extremely premature infants for whom life outcomes are highly unpredictable. However, the report made no comment on the ethics of therapeutic abortion, and it should not be read as doing so. Therapeutic abortion is only permitted up to 24 weeks’ gestation, if two doctors‘ medical opinion is that ending the pregnancy is necessary in the interests of the individual woman’s physical or mental health.

‘Nuffield’s ethicists have not conducted new research on fetal viability for this report, but are basing their comments on previously published evidence. Although we should always take note of what ethicists have to say in these areas, the report does not offer any new evidence about any medical advances which might affect abortion.’

Report Recommendations

‘Do not revive’ earliest babies, BBC News, 15 November 2006

Critical care decisions in fetal and neonatal medicine: ethical issues, Nuffield Council on Bioethics, 16 November 2006

Also read:

RCOG ethics paper hits the headlines, Abortion Review, 7 November 2006

On the Nuffield Council’s ‘Critical care decisions in fetal and neonatal medicine: ethical issues’, Royal College of Obstetricians and Gynaecologists press release, 15 November 2006