9th grade research paper
Celia Brecht Honors Freshman English Mr. Fry 9 February 2013 Ethics in Neonatology: Save the Babies! Ethics are a big part of neonatology. Ethics involve the treatment of the newborn and who gets to decide their treatment plan. The history of neonatology has greatly affected the way ethics are viewed today. When neonatology was relatively new, doctors often did not care about the infant’s pain. Because physicians know about the pain of a newborn now, they can assess the treatment plans better, therefore usually winning the ethics battle.
Neonatology is a branch of pediatrics involving care or newborn, sick, and premature babies (“The History of Neonatology’).
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Even though it can be a sad profession, neonatology is a critical part of modern medicine. One in every eight babies is born premature and prematurity is the number one cause of death in newborns (“The History of Neonatal Intensive Care Units”). Six percent of infants who are born are admitted to the NICIJ (“The History of Neonatology’). NICIJ stands for neonatal intensive care unit and is an area devoted to the care of critically ill babies (Mackler).
This is the area of the hospital where neonatologists do their aily work. An infant born earlier than 37 weeks is to be considered premature. There are three critical things that a neonatologist must worry about in a premature infant because they have not had the time to let their internal organs fully develop yet. The first is their lungs. The infant is often not able to breathe on its own, so it is put on a respirator to breathe for them. The second thing is the brain. The brain is not developed enough so the baby is incapable of sucking or swallowing.
They cannot latch on to a bottle or the mother’s breast yet, so they are fed through a tube. The last hing a neonatologist has to worry about is the immune system. The baby isn’t in the womb long enough to receive the full complement of antibodies to ward off infections and diseases, so they are more prone to getting sick (Berkhow Beers and Fletcher 1148). Doctors also are required to do repeated blood tests to monitor functions of the liver and kidneys (Family Health Guide). Improvements in neonatal medicine have brought drastic changes to survival rates of premature born babies.
Since 2006, newborns as small as 450 grams and born as early as 22 weeks have a chance of survival (Lemmons). Infants born at 24 weeks or less have greater chance of survival, but are at more of a risk for blindness, deafness, cerebral palsy, and learning problems. (Family Health Guide). In modern NICIJs, infants weighing more than 1000 grams and born after 27 weeks have ninety percent chance of survival with normal neurological (brain) development (Lemmons). Development in neonatal care has lead to decreases in infant mortality.
These decreases have been brought upon by better treatments for physical and mental conditions and improvement to the quality of life for surviving infants (Mackler). Neonatal history begins in France in the late 1800s. The very first incubator was developed by French nurses and midwives and was modeled after an incubator used for baby chicks (Encyclopedia of Family Health 1337). An incubator is used to keep the newborn at a safe, standard body temperature so it doesn’t get hyper or hypothermic. The use of the incubator then spread to the United States where Dr.
Joseph B. Lee established the first premature infant incubator station in Chicago in the early 1900s (American Academy of Pediatrics). A rapid escalation in neonatal care was brought upon by ventilation of premature newborns. This helped smaller newborns that were not able to breathe on their own (Lemmons). The specialty of neonatology began in the United States in 1960 (“How We Got Here”). Soon after neonatology was first introduced, a large number of pediatricians devoted themselves to full-time neonatology (Phillip).
The very first NICIJ was established in October 1960 at Yale-New Haven Hospital. These first NICIJs were only designed to stop the spread of disease by separating sick babies from healthy babies, rather than what they are made to do to day, to make sick and premature babies healthier (Encyclopedia of Family Health 1337). In 1973, clinicians first brought the ethics issue to attention (Fleischman). Before this, pain and discomfort in a newborn was not seen as a priority. Babies were operated on with little or no anesthesia (Rutter).
In 1984, United States Congress amended the first child abuse law pertaining to overseeing the withdrawing of medically indicated treatments from neonatal patients (Fleischman). But the ethics of neonatal care has developed even more in Just the past 15 years. Both substantive and procedural issues have been addressed (Mackler). Procedural discussion focuses n who has the authority to say what medical care the infant will receive. The potential decision makers are parents, physicians, ethics/infant care review committees, and state courts (Mackler).
Substantive issues focus on the appropriate standards for making treatment decisions, and also presents various options for patient care. There are 4 total options for treatments on newborns. They are as follows: 1 . Treat every newborn aggressively as possible. 2. Provide selective treatment based on balance between direct benefits and burden/ costs of care. 3. Focus on the best interests of the particular infant. Treatment should only be used if the infant is suffering or the quality of life for the baby would burden the parents and the child in the future. . Only consider the financial cost of the family, and provide care for only what the family can afford (Mackler). Ethical issues were raised by fact that physicians and doctors ignored the existence of pain in the newborn for so long (Rutter). Physicians and parents often disagree over what is in the best interest of the child, but if a wrong decision is made, the decision ends up falling under Jurisdiction of the state laws concerning child protection. This is why the authority to make the decision of patient treatment is so highly debated (Fleischeman).
Up to twenty percent of extremely premature survivors will have a disability and many more will have severe to minor behavior difficulties when they reach school age. This leads to the question, “Is attempting to save the life of a baby who will have disabilities a wise use of money and resources? ” The ethics of neonatology can be good and bad. If the decision maker decides to end the child’s life because a of burden on a family or the child, it isn’t good. The baby should be iven as much care as possible until you cant do anything more.