Primum non nocere — first do no harm — is the cornerstone of the Hippocratic Oath. Just because doctors can intervene, doesn’t mean they should. Dr Daphne Austin, an NHS official, has kicked off a fierce debate by saying that keeping alive babies born at 23 weeks does more harm than good, and that the money would be better spent elsewhere. But relying on hard and fast thresholds is fraught with difficulty.
There is no such thing as the average premature baby, and paediatricians cannot give parents an accurate prognosis. There are lots of factors at play, not least the condition of mother and baby, and the medical skill and paediatric facilities on hand. Overall, survival of 23-week babies may be as low as 10 per cent, but in the best units it’s closer to 25 per cent.
Will he or she end up with some form of long-term disability such as deafness, cerebral palsy or epileptic seizures? Probably. But could the baby emerge relatively unscathed? Possibly. Can any doctor accurately predict the outcome for each and every baby? No, and amid all this uncertainty it is only natural that parents and doctors hang on to whatever hope there is.
A rigid cut off of 24 weeks, below which no baby would be resuscitated, may make economic sense — it may even make moral and ethical sense given the likely toll on the child’s health as he or she gets older — but try telling that to the parents, doctors and midwives watching a baby, born at 23 weeks and 6 days, gasping for breath on the labour ward. And by the time they can think about the ramifications of their decision to resuscitate the child, it’s too late to turn back the clock.