The following is an excerpt from the testimony of Dr. Robin Pierucci, MD, a neonatologist and medical director of a 50-bed neonatal intensive-care unit. She was one of the witnesses at the Tuesday hearing “End Infanticide: Examining the Born Alive Abortion Survivors Protection Act.”
1.) What is the medical standard of care for tending to all newborn babies? At birth, all babies are to be evaluated and receive the necessary degree of intervention that is outlined by the Neonatal Resuscitation Program (NRP).This guideline is based on the evidence compiled by the American Academy of Pediatrics (AAP) and the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of the Neonate. This program was devised to help the medical personnel “learn the cognitive, technical, and teamwork skills…to resuscitate and stabilize newborns.” This is the medical standard of care all newborn infants are to receive. This is the standard of care medical staff are expected to provide.
2.) Is NRP applicable to premature babies? Absolutely. In fact, because premature babies will encounter greater/more frequent challenges than term babies in transitioning from intra-uterine to extra-uterine life, the NRP program specifically addresses how to resuscitate our sickest, most immature babies.
3.) How immature can a baby be, and the staff attempt to resuscitate? The current edge of viability is approximately 22 to 23 weeks gestation; however, (while there is no guarantee of our success), overall our ability to resuscitate these young lives, continues to improve. There is now published evidence of resuscitation and survival of very premature infants as young as 21 weeks 4 days gestation. Let me be clear, I personally have cared for babies at 22 weeks, but not at 21 weeks. At the edge of viability, it is with the utmost humility that we must evaluate the specific nuances of each individual case—ethical medical decision making is complex, and given the risks involved, just because we can does not automatically mean that we should.
4.) Which babies are not automatically resuscitated? The babies with the issues stated by the NRP guidelines whose diagnoses have been confirmed beyond a reasonable doubt, and the family as well as the members of the health care team agree that initiating resuscitation will cause greater harm than good. If this is not the case, then consistent with the standard of care for all other human beings, we always attempt to resuscitate the baby, and then sort out any underlying pathology. In cases where our technology is insufficient to help the baby, it is appropriate to provide “comfort” or palliative care. The goal of this kind of care is to help the baby and their family live well with what we do not have the ability to “fix”. In such cases we not only try to avoid uncomfortable tests and procedures that will either solve nothing or prolong suffering, we also strive to minimize IV tubing and monitors that may interfere with a family’s ability to simply hold their little one. It is paramount to remember: the baby’ s first and primary diagnosis is, it’s a baby. All the other diagnoses are secondary and do not ever negate the first one. Because of diagnosis number one, (it is a baby), we are always obligated to care, whether or not we have the ability to heal.
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5.) Have I ever intentionally ended the life of a baby? No. I do not ever intentionally end anyone’s life.
6.) What about the babies whose parents don’t want them? In ethics there is something called the Principle of Double Effect. This principle explains that reaching a good goal (helping a woman who is also pregnant), can never be ethically accomplished by a bad means (intentionally killing someone—the woman who has a problem, someone who may have harmed her, or the baby). None of these deaths are ethical ways to solve the mother’s problems. Likewise, the “wantedness” of the baby also does not determine if it is ethically permissible to intentionally kill him or her, either before or after birth. Yes, there are instances of fetal demise which occur as a consequence of keeping the mother safe. This is ethically and medically very different from the intentional destruction of another person’s life. Whether or not she wants the baby to live, murder is always intrinsically wrong.
