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Limits of viability: An ethical gray area

Despite the advancement of medical technology, research has shown that premature birth rates are increasing. Massachusetts parents of premature infants may face heartrending decisions in the hospital and long-term struggles to ensure the wellbeing of these children. The complications surrounding a preterm birth are only worsened by medical errors.

According to MassLive, March of Dimes found that the rate of premature births in the United States went up in 2016, a circumstance that has not occurred for nearly a decade. With 8.4 percent of births in Massachusetts qualifying as preterm, the state earned a B on the March of Dimes Premature Birth Report Card and ranked 19th in regard to racial disparities in preterm birth rates. Although Massachusetts scored well overall among the 50 states, this percentage of premature births still leaves plenty of room for tragedy.

The National Center for Biotechnology Information provided a review of the ethical issues involved in medical decisions related to preterm infants. The NCBI notes that under the Born-Alive Infants Protection Act of 2001, the law extends personhood to all infants born with voluntary muscle movements, the ability to breathe and a heartbeat. In practice, however, there are developmental limits to infant viability, which were acknowledged by the House Judiciary Committee. For example, an overwhelming majority of physicians argued that resuscitation is not a worthwhile option for preterm infants born at or before 23 weeks, although treatments for infants born at or after 25 weeks of gestation are more likely to be successful.

Thus, there is a gray area for resuscitation of infants born between 23 and 25 weeks of gestation. For preterm infants born during this time span, physicians have an ethical requirement to act according to both parental wishes and the infant’s best interests. The NCBI reports that in some cases, such as Miller v. HCA (2003), the physician may override parents’ instructions and resuscitate the newborn. In states where physicians may act without informed consent in emergencies, the issue of resuscitation of premature infants can be complicated, particularly when the physician acts against the parents’ wishes. 

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