A Bioethical Dilemma

A popular topic of conversation lately among my friends, as well as an issue in a recent episode of Grey's Anatomy, has had me thinking about the following bioethical dilemma: in the event of a situation that requires choosing to save the life of a woman or her unborn infant, what should one do? What are the implications of both choices? Is it possible to save both lives?


Of course, situations like these are completely dependent on the circumstances of both mother and infant. However, some generalizations can be made. I feel very strongly on this issue, so I thought I would share my thoughts. :)


I am a strong advocate of preventing harm to the baby, while saving the life of the mother. Now, when this gets tricky is when treatment to the mother will be harmful to the baby. In this particular episode of Grey's Anatomy (Season 7, Episode 18), Callie's heart stopped beating on the operating table. The baby was only 23 weeks along, making delivery of the baby risky and viability of the baby questionable. Arizona and Mark argue about whose life should be their first priority. Arizona advocates for Callie's wishes, since she so desperately wanted a baby, saying: "What is her life going to be like without this baby?" Mark quickly retorts: "What is her life going to be like if she's DEAD?"


This is a valid point. However, what is important here is that there are two human lives at stake, not just one. We know the risks associated with severe trauma such as that found in an adult in a car accident—brain swelling, internal bleeding, broken bones, etc. If these injuries are so severe that delivery of the baby is required to save the baby's and/or the mother's life, what are these risks associated with delivery of a pre-term infant?


Here are some facts about premature infants from the March of Dimes:

"Premature babies [born before 37-40 weeks gestation] face an increased risk of lasting disabilities, such as mental retardation, learning and behavioral problems, cerebral palsy, lung problems and vision and hearing loss. Two recent studies suggest that premature babies may be at increased risk of symptoms associated with autism. Studies also suggest that babies born very prematurely may be at increased risk of certain adult health problems, such as diabetes, high blood pressure and heart disease."

Look at just the physical differences between a 26-week preemie (left) and a full-term infant (right):

  

If the baby is born before reaching 28 weeks, these risks are greatly increased:

"Most of these babies are born at extremely low birthweight (less than 2 pounds, 3 ounces). Almost all require treatment with oxygen, surfactant and mechanical assistance to help them breathe. These babies are too immature to suck, swallow and breathe at the same time, so they must be fed through a vein until they develop these skills. They often cannot cry and they sleep most of the day. These tiny babies have little muscle tone, and most move very little. These babies are at high risk for one or more of the complications discussed above [respiratory distress syndrome, apnea, intraventricular hemorrhage, patent ductus arteriosis, necrotizing enterocolitis, retinopathy of prematurity, jaundice, anemia, chronic lung disease, and infection]. However, most babies born after about 26 weeks gestation do survive(about 80% survive at 26 weeks), although they may face an extended stay in the newborn intensive care unit (NICU). Factors that can improve survival rates include higher birthweight, female sex, history of prenatal treatment with corticosteroids and singleton birth. Unfortunately, about 25 percent of these very premature babies develop serious lasting disabilities, and up to half may have milder problems, such as learning and behavioral problems."

So if this baby is not only going to have to fight for its life in the short term in order to grow and develop outside of the mother's womb, but will also have increased risk for health problems later in life, what's the point of trying to save the baby? Wouldn't it be easier to devote all resources to trying to save the mother's life?


I would argue that the baby's life is just as important as the mother's. Just because the baby could have problems later in life does not make his or her life less worth saving than that of the mother. Besides, who are we to say that one human life is worth more than another? The baby is a new person with infinite possibilities in his or her life. While some will argue that a special needs child often breaks apart a family, I have seen firsthand the exact opposite. I know several families with children that have autism, Down syndrome, and other birth defects or diseases (due to prematurity or otherwise), and the special care and love that these children require brought their families together in a way they never thought possible. This baby is a human person that has unique DNA, fingerprints, and will develop a unique personality, if only given the chance to grow and mature.


So the bottom line is—yes, do whatever is necessary to save the life of the mother. But in doing so, do not forget the life of the tiny infant that is so much more vulnerable and dependent on his mother, doctors, and family for support and medical care to grow into a strong and healthy baby, child, and adult.