Friday, November 17, 2006

Inaccurate précis

In today's column, Polly Toynbee writes:

The Nuffield's eminent group of professors of law, medicine and ethics drew up the guidelines...

The group was actually wider than this. It also included campaigners, a doctor of social anthropology, a health economist, and a solicitor (source).

She also says that:

They recommend that babies born before 23 weeks should not be resuscitated, as only 1% of these survive and a high proportion of those will suffer severe disabilities. Between 23 and 24 weeks the prognosis is poor - most die and two-thirds of the survivors end up disabled - but they say parents should make the final decision. Once a baby reaches 25 weeks, intensive care should normally be given, and half will live.

In fact, the report (pdf link available here) makes a very clear distinction between babies after 23 and 24 weeks. To quote from paragraph 23 of the executive summary:

(c) Between 24 weeks, 0 days and 24 weeks, six days of gestation, normal practice should be that a baby will be offered full invasive intensive care and support from birth and admitted to a neonatal intensive care unit, unless the parents and the clinicians are agreed that in the light of the baby’s condition (or likely condition) it is not in his or her best interests to start intensive care. (d) Between 23 weeks, 0 days and 23 weeks, six days of gestation, it is very difficult to predict the future outcome for an individual baby based on current clinical evidence for babies born at this gestation as a whole. Precedence should be given to the wishes of the parents regarding resuscitation and treatment of their baby with invasive intensive care. However, when the condition of a baby indicates that he or she will not survive for long, clinicians are not legally obliged to proceed with treatment wholly contrary to their clinical judgement, if they judge that treatment would be futile

In neither of these scenarios do they say "parents should make the final decision" -- in (c) if the parents don't want treatment but the clinicians do, the paper will be offered "full invasive intensive care and support from birth". And in (d), if the parents want treatment, they point out that clinicians are not obliged to proceed -- "precedence" is given to the wishes of the parents, not final decision-making rights.

1 comment:

James said...

Your corrections make her article slightly less disturbing. She feels that many of the 23 week births survive, but not the majority, and that this is an argument that viability is not attainable at that age. SPUC should be very grateful for her contribution.