To the Editor:
In "End of Life, at Birth" (Op-Ed, Aug. 5), April R. Dworetz addresses the problems of the extremely premature infant, discussing the heroic measures used to keep "Miracle," a one-pound, 23-week-gestation baby, alive.
Dr. Dworetz is correct in pointing out that parents are often completely unprepared to make life-and-death decisions about their premature infant and that they should be better informed. As an experienced pediatrician, I have been involved with many of these "miracle" babies and their parents over many years.
When parents are in doubt or confused as to the best course of action, I have found it helpful to ask them to ask me the following question: "Dr. Eden, what would you do if this were your baby?" My answer, based on my knowledge of the statistics for serious permanent neurological damage and survival, has often helped them make an informed decision.
ALVIN N. EDEN
New York, Aug. 5, 2013
The writer is a clinical professor of pediatrics at Weill Cornell Medical College.
To the Editor:
April R. Dworetz raises crucial issues concerning "informed" decision making for lifesaving treatments by parents who give birth to premature babies.
As a society, we must acknowledge that the decisions of parents affect all of us, and include bearing the often extraordinary costs of keeping these babies alive after birth, and for some, through their lifetimes. We participate in the cost of these decisions through health insurance premiums and taxes.
That is why the Affordable Care Act seeks to insure all people, young and old, healthy and ill, to spread the coverage and the responsibility. Do those opposed to Obamacare wish to exempt themselves and their families from the coverage it avails? Or do they just expect the rest of us to pay?
MARY FRANKEL
Bryn Mawr, Pa., Aug. 5, 2013
To the Editor:
April R. Dworetz presents the heart-rending dilemma facing parents and doctors when they must decide to save or allow to die many-weeks premature infants, some with prebirth disabilities.
Clearly, a first step in this tragic matter should be directed to ensuring the normal gestational period for mother and child. How can (especially very) premature deliveries be lessened and made rare? Is there a medical obligation to resuscitate a one-pound infant who is already clinically dead? No. But the one-pound infant, live or resuscitated, is struggling to continue living. What help does he or she deserve to survive?
The premature infant struggling to live deserves every help medical science can give him. "Miracle," Dr. Dworetz's name for the one-pound premature infant in her care, was likely to be discharged after extensive treatment but with chronic lung disease. Is that a reason to regret her survival? Will this disease be overcome by medical science in decades to come?
Our tiny brothers and sisters, if they cannot be saved, will be surrendered to a merciful God. But all such infants living and struggling to continue living deserve all the help we — parents, doctors and society — can give them.
(Msgr.)
DANIEL S. HAMILTON
Lindenhurst, N.Y., Aug. 6, 2013
To the Editor:
I have assisted families of the elderly, dying adults and parents of compromised infants and dying children for the last 45 years. In my experience, the issues involved require psychological sensitivity training that begins in medical school, continues throughout the physician's practice and includes nurses and social workers as well.
In addition, these professionals benefit from psychological support to carry out this most challenging and essential of tasks.
ROBERT A. NOVER
Orleans, Mass., Aug. 7, 2013
The writer is a child and adult psychiatrist and psychoanalyst.
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