I have recently faced an ethical dilemma. I want to hear the thoughts and opinions of people on this issue.

Now, what I present to you is fictional (due to HIPAA laws), but somewhat relates to my experience. I will give you a hypothetical situation and would like to hear your input.

A woman presents to the hospital with vaginal bleeding... she is told that she is pregnant. The tests reveal that she is 23 weeks and 2 days pregnant. The earliest gestational age for survival is 24 weeks gestation.

The patient is diagnosed with a placental abruption (placenta breaks away from the uterine wall), which causes bleeding and both the mother and child are at risk for death due to bleeding out.

Now, an emergent cesarean section is called. The fetus is delivered with a heartbeat, but is not breathing. This baby weighs a little over one pound... 520 grams.

The least a fetus can weigh, according to medical standards is 500 grams, in order to "save" it's life.

Knowing that this baby may not live the flight to a high risk medical center, and knowing that this baby most likely (almost 90%) will have permanent mental and/or physical impairments, what do you do?

Before you answer... the mother of the child does not know she is pregnant before this episode. She is in complete denial and states that she is not ready for a child, but wants you to save the life nonetheless. What do you do?

I would do what I could to save the child which may die despite all interventions. My neighbor was around a pound when he was born, was supposed to die, but grew up to become a lawyer for a major Chicago bank, married a wonderful woman, and had four beautiful children.

There's a big difference between what I would do and what I would want to do.

I'd save the child, because legally I have to. It's above the legal weight. I have no choice. I have to.

Now, if it was my choice, I'd wait to see what happens. If the baby is breathing on its own then I won't interfere, but neither would I interfere if it stopped breathing.

I'd do everything that I'm expected to do. Get the baby warm, clear the airway, etc. etc, but I wouldn't do anything drastic to save it's life.

The thing is, in the situation you described, you have no choice. The mother is begging you to save her babies life. The baby is above the legal weight. You have to try, even if you secretly hope that you fail, because the baby only has a 10% chance of a normal life.

Having said all of this, I truly believe that in cases like these, the outcome isn't in our hands. If this life wasn't meant to be then it wouldn't have been saved, with or without your intervention.

It's early days yet, this child could still die. Maybe that's for the best. Maybe he/she will surprise you and be one of the 10% that lives a normal life.

I do know that you did what had to be done. It's not in your hands. It probably never was. Whatever happens is what's meant to happen. For better or for worse.

However, the legal age of gestation is 24 weeks... this fetus was LESS than 24 weeks according to the ultrasound. But the weight as 2 ounces over the legal weight.

Now... to add insult to injury... Mom gets released from the hospital but continues to deny that she was ever pregnant.

Again, this is all hypothetical. Based on a true story, but certain names and situations have been changed to protect the innocent.

Alty's on the right track, but it's like the no tolerance policy of not bringing knives to school and the kid brings in a knife so that someone can cut his cake. He gets expelled and a bru ha ha erupts.

Your not allowed judgement when there is policy.

You policy didn't include the other variable. Your policy is only based on weight. Should policy allow judgement or should the policy be God?

Nothing heroic. Baby wasn't old enough to have an advance directive.

I think you should be allowed to use judgement or some amount of judgement should be in the policy. It should not be just weight.

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Originally Posted by KeepItSimpleStupid

It should not be just weight.

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That's just it. It's NOT just weight. It's also gestational age, which is 24 weeks. Since mom denied knowing she was pregnant prior to this incident.

According to the ultrasound she was 23 weeks and 2 days. That is 5 days earlier than the earliest date of possible survival for gestational age.

You see, we must meet at least 2 criteria. In this case, only one was met.

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Originally Posted by J_9

However, the legal age of gestation is 24 weeks...this fetus was LESS than 24 weeks according to the ultrasound. But the weight as 2 ounces over the legal weight.

Now...to add insult to injury...Mom gets released from the hospital but continues to deny that she was ever pregnant.

Again, this is all hypothetical. Based on a true story, but certain names and situations have been changed to protect the innocent.

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So she's denying this child?

This has just become a case of medical advancement being a bad thing.

Fifty years ago this baby wouldn't have had a chance. Heck, the mother would have been in danger too, more so then she was. Nature would have selected, and the baby would have lost the battle, maybe for the better.

There are times when I have to question all the advancements we've made. We're so busy trying to see if we can that we don't stop and think if we should. Who decides when a baby is at the right gestational age or weight in order to survive? Who decides that a 10% chance at a normal existence is good enough?

You weren't the decision maker J, you were the rule follower. You did what you had to do. If you had gone any other way then it would most likely have come back to bite you in the butt. I know that's little consolation but that's the way it is. You did your job, no more, no less.

As for the mother, hopefully she'll come out of her funk and realize what's going on, come back to claim her child, for better or for worse. She seems to be in a state of denial. If the baby had been carried to term she still may have had this reaction. There's a lot on her plate right now. The fact that she didn't realize she was pregnant and now giving birth to a child that will most likely need constant care for the rest of its life. It's a lot to take in. Give her time. I hope she comes around.

Now I'm going to say something that a lot of people will probably disagree with. Thank goodness this is in member discussions and no one can reddie me, because I'm sure that there are a few that will want to.

Personally, my hope is that the baby dies. This poor little mite doesn't deserve the life its been given. The 10% chance is nothing, the odds aren't in his/her favor. His/her mother is in denial and doesn't seem ready to have a healthy child, much less a child that will probably never live a normal life. The best for this child would be for it to drift off, go back and take a place in line to come back again in another child.

That's my opinion.

Anyone can feel free to disagree and I'm sure many will.

Bring it. ;)

I think then it's oops on your part. The piece of info that she didn't know she was pregnant is a bit hard to believe and should have nudged it more to the creiteria.

You could be under the spotlight next. That would not be good.

Virtual greenie for Alty.

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Originally Posted by J_9

That's just it. It's NOT just weight. It's also gestational age, which is 24 weeks. Since mom denied knowing she was pregnant prior to this incident.

According to the ultrasound she was 23 weeks and 2 days. That is 5 days earlier than the earliest date of possible survival for gestational age.

You see, we must meet at least 2 criteria. In this case, only one was met.

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Is that why you're kicking yourself sweetie?

Did you have the option to walk away and chose not to?

If so, you made that decision for a reason. I know you well enough to know that you don't make decisions like this lightly. You chose and the child is alive. You did what you thought was best at the time. Don't go back on that decision now.

J, you are a kind, caring, compassionate, wonderful person. Heck, that's just the basics, there's so much more. You are one of the handful of people on this site that I consider a good friend. I trust you, I adore you. You can be a toughie, but deep down you're just a big softie, like me. Ya, I know, it was supposed to be our secret, but... ;)

Do not let this haunt you. You chose. Time will tell what happens. It's out of your hands. Do not second guess yourself because I know this decision wasn't made lightly.

Chin up chickie. Don't make me haul my butt over to your place and kick you with my thigh high red leather boots. ;)

Personally Would do everything to save the child's life. Every child is precious. That is what I would have done. To Do everything they can to help give a child a fighting chance no matter what might or might not happen.

Edit: I would also like to add that whatever decision was made whether it be considered good or bad does not matter. This is a new experience but it will help form what decisions might need to be made at another time in a different situation. Whatever you did, you did the right thing.

Best wishes in your career,.

Joe

Hi J.

I don't know much about laws or medical stuff but what I do know is that life gives us some tough choices, and this definitely was one of them.

If it were me, I would simply follow orders. If the mom wanted me to fight to save her baby I would, if she didn't I wouldn't. What good would come to save a child's life if it were to be unwelcomed into a home where it is not wanted.

Well, I have a ton of respect for you J and whatever decision you make/made I'm sure was the "right" one.

If this baby lives, I wish it a long healthy life.

...that's just my opinion

I agree Muddy.

J, you did what you had to do, no one can do more.

I too hope that this baby is in the 10%, not the 90%. I also hope it's mom come around, realizes what a gift she's been given.

Still, a part of me just wishes peace for this child. An eternal rest.

Only God can decide. We just stand by and watch.

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Originally Posted by Altenweg

Did you have the option to walk away and chose not to?

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Unfortunately I did not have the option to walk away. I had to do this. We all were crying during the resuscitation, including the 75 year old male pediatrician.

I guess I'm beating myself up over nothing. There were no other options for me. :(

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Originally Posted by J_9

Unfortunately I did not have the option to walk away. I had to do this. We all were crying during the resuscitation, including the 75 year old male pediatrician.

I guess I'm beating myself up over nothing. There were no other options for me. :(

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If walking away wasn't an option then you're right, you are beating yourself up over nothing.

Even if you had the option to walk away, you still did your job.

Stop beating yourself up. I'll tell Ben on you! ;)

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Originally Posted by Altenweg

If walking away wasn't an option then you're right, you are beating yourself up over nothing.

Even if you had the option to walk away, you still did your job.

Stop beating yourself up. I'll tell Ben on you! ;)

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I guess it's something I'll get over in time. I hope next time is easier.

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Originally Posted by J_9

I guess it's something I'll get over in time. I hope next time is easier.

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I hope it's easier for you too. Just remember dear, you can't save the world, that's my job. ;)

Big hugs to you. I know I'd be feeling the same way if I was in your shoes. Having said that, I also know you'd be telling me what I'm telling you, if the roles were reversed.

Having had no choice, you did what you had to, J.

Personally, I think it's a crying shame that resources are going to be used on an unwanted infant that has a very low chance of survival.

I can only imagine the heartbreak you are going through, though. Lots of hugs to you.

Thanks Synn. I know I did what I had to, and I really hope that something good does come out of this.

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Originally Posted by J_9

I know I did what I had to, and I really hope that something good does come out of this.

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I'm proud to know you, J, very proud. I will keep my wholly holey holy pea green t-shirt after all and not tease you any longer.

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Originally Posted by Wondergirl

I'm proud to know you, J, very proud. I will keep my wholly holey holy pea green t-shirt after all and not tease you any longer.

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Thank you WG... that means a lot to me! :D