Medical breakthroughs raise complicated ethical questions

September 10, 1990|By Jean Marbella

New drugs and technology make it more likely that extremely premature infants will live, but they don't solve the ethical question of which lives are worth saving.

Some premature babies, for example, will suffer lifelong problems such as retardation and developmental delays because they were born before all their organs and systems could mature.

The McCoys, who live in Catonsville, and the Chapmans, who live in Chase, say their babies seem fine and their only remaining concerns are possible hearing or sight problems that may have resulted from the use of oxygen before babies could breathe on their own.

But other babies are not as lucky. And doctors say save-or-not-save questions can be answered only on a case-by-case basis.

"You save a preemie, and most of those children will do well," said Dr. Ira H. Gewolb, chief of neonatology at University of Maryland Hospital. "If ababy may not be perfect, there are degrees of perfection. With mental retardation, you might have an occasional cerebral palsy, but milder degrees are more common."

"The most difficult issue in neonatology is where to draw the line," said Dr. Ambadas Pathak, head of newborn medicine at GBMC. "When I started in this field in the '60s ... you used to have to have the baby be more than 3 1/2 pounds and survive 24 hours before you would do anything" to save the baby.

"It's a complicated question, the proper selection of patient and treatment, and you hope the benefit you're trying to accomplish is greater than the risk. Those are judgment calls you have to make."

Synthetic surfactant, of course, is not the magic bullet that will save all premature babies.

"It doesn't cure prematurity," said Dr. Christine Gleason, director of the neonatology clinic at Johns Hopkins Children's Center. "It gets you out of the delivery room, but there are still problems down the road."

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