Viewpoint: A response to a writer's challenge
Steve Lagoon (Viewpoint, Dec. 10) challenges me to show evidence that the Illinois bill Barack Obama opposed would have required resuscitative medical treatment for pre-viable fetuses, as opposed to simple palliative care.
Here is the operative phrase: the bill would have required the physician to "exercise the same degree of professional skill, care and diligence to preserve the life and health of the child as would be required of a physician providing immediate medical care to a child born alive in the course of a pregnancy termination which was not an abortion."
The bill did not call for swaddling the infant and singing lullabies; it called for life preserving care.
This is what neonatal resuscitation, that is, life preserving care, entails: First, the practitioner would insert a laryngoscope into the infant's throat, and then an endotracheal tube would be inserted into the trachea and advanced to a point just below the infant's vocal cords, then taped securely to the infant's face.
The infant would then receive positive pressure ventilations through the ET tube, using an ambu bag attached to an oxygen source.
This is an extremely delicate procedure because even a little too much pressure on the ambu bag can collapse a neonate's fragile lungs. Moreover, a pre-viable infant does not have lungs mature enough to effectively exchange oxygen and carbon dioxide, so, the required procedure would, in any case, be futile.
If the infant does not have a good pulse rate within 30 seconds of initiating positive pressure ventilations, chest compressions are initiated.
Bear in mind, we are talking about an infant that weighs about one pound or less; the risks of chest compression, even in a full term infant, include broken ribs, lacerated liver, lacerated heart, collapsed lung.
At the same time as the positive pressure ventilations and chest compressions are being administered, another practitioner will thread a catheter into the neonate's umbilical vein, for the purpose of administering intravenous medications such as epinephrine.
Laws vary from state to state, but, generally, if the neonate is not able to sustain a heartbeat after 10 to 20 minutes of treatment, then the resuscitation is considered unsuccessful, and will be stopped.
Physicians and nurse practitioners regularly determine viability and make decisions regarding the use of resuscitation in pre-term deliveries.
The bill Obama opposed would have taken that judgment call away from health care professionals, and for that reason the Illinois State Medical Society fought the proposed legislation, and issued a statement asserting that the bill "interfered negatively with the physician-patient relationship, attempted to dictate the practice of medicine for neonatal care and greatly expanded civil liability for physicians."
No one, Mr. Lagoon, objects to providing comfort measures for a pre-viable infant born with vital signs.
What was objectionable in the bills Mr. Obama opposed was the requirement of extraordinary measures for pre-viable infants (once a fetus is delivered, it becomes an infant, or a neonate), measures which would tend to make early-term abortions untenable.
We can, and do, disagree on the need for reproductive rights, and we can discuss that at another time; certainly, though, we can agree that subjecting a pre-viable infant, an infant with no possibility of surviving, to the rigors of neonatal resuscitation, is both cruel and unnecessary.
Denn is a resident of Woodbury.