July 25, 2005
Low Birth Weight Baby Development Problems Raise Ethical Question

Should radical measures be employed to save low birth weight premature infants?

Asthma, cerebral palsy, vision and hearing disorders, low I.Q., poor school performance and social difficulties are among the problems described in The Journal of the American Medical Association by doctors at Rainbow Babies and Children's Hospital in Cleveland. Such disabilities were far more common in the children born prematurely than in normal-weight children from similar backgrounds. For example, 38 percent of those born prematurely had I.Q.'s below 85, as opposed to 14 percent of the normal-weight children. Among the premature, 21 percent had asthma, compared with 9 percent of those with normal weight.

The babies looked at in this study weighted 2.2 lbs or less at birth.

A look at 219 such children born between 1992 and 1995 found 14 percent had developed cerebral palsy, 21 percent had asthma, 38 percent had an IQ under the threshold denoting retardation, 47 percent had poor motor skills, 10 percent had very poor eyesight, and roughly two-thirds were characterized as having "poor adaptive functioning" and "functional limitations," the study said.

Maureen Hack, an expert on premature births at Case Western Reserve University, led the study published in the Journal of the American Medical Association.

About 23,000 very low birth weight babies are born in the United States every year.

Of the 23,000 babies born in the United States in 2002 weighing between 1.1 to 2.2 pounds (500 and 999 grams), 70 percent survived, according to the report.

Check out the total percentages for different ways of categorizing the problems with low birth weight premies.

  • Functional limitations, such as difficulty seeing, hearing, speaking, or communicating (64% versus 20%, OR 8.1; 95% CI 5.0-13.1)
  • Compensatory dependency needs, such as a regularly prescribed medication (48% versus 23%, OR 3.0; 95% CI 1.9-4.7)
  • Need for services above those routinely required by children, such as special school arrangements (65% versus 27%, OR 5.4; 95% CI 3.4-8.5).
  • Advances in biomedical technology lead to increases in the number of very premature babies that survive and have problems.

    A JAMA editorial refers to Hack's findings as ``disappointing news.'' While more babies are surviving at low weights, the long-term outcome has not improved in the last decade or so, the writers say. In fact, they say, the proportion may have worsened as more babies survive.

    Hack, though, said she doesn't see these numbers as disappointing. Only 8 percent of the low-birth-weight babies were unable to walk without help at age 8, which means that 92 percent were walking on their own. And just 6 percent had trouble feeding themselves, while only 7 percent were unable to socialize or play with others.

    Hack said one surprising finding was that even low-birth-weight babies with normal IQs were prone to have trouble in school.

    ``In the past, we looked at a normal IQ over 85 and we expect the child to do fine,'' she said. ``But we're finding they also have problems at school. Even children who are basically functioning OK do have substantial learning problems.''

    There is an old saying about a box being either half empty or half full. Hack thinks it good news that only 8 percent of these premies can't walk at age 8. I see it as a terrible tragedy.

    Also, Hack is wrong to be surprised at the number of premies who have trouble learning. The intelligence level "g" matters (PDF format). If 38 percent are retarded then a large percentage are above the retardation level but still well below the white average IQ of 100. Put that 100 IQ into perspective. One needs 120+ IQ to work at the more demanding jobs such as doctor, lawyer, veterinarian, engineer, or middle manager. The bulk of these premies are not headed for even moderately above average IQ jobs such as clerk, retail store manager, or mechanic. A large fraction of them - perhaps even a majority - will spend their lives as wards of the state.

    These results raise the question of whether low weight birth babies should be treated with such extraordinary measures to keep them alive. I would be interested in hearing views from readers in the comments section.

    Also, note that while advances in biotechnology will eventually lead to the development of artificial wombs which a premie baby could be transferred to at birth do not expect such technologies to eliminate all the medical problems reported above. Some of the premature births are happening because the developing fetus has already developed problems. Some of the premature births are due to genetic flaws. Others are due to toxic exposures that happened while still in the mother's womb. So at birth the defects are already present.

    Update: Also see my previous post "Premature Birth Produces More Lasting Brain Effects In Boys".

    Share |      Randall Parker, 2005 July 25 11:39 AM  Bioethics Debate


    Comments
    toot said at July 25, 2005 11:55 AM:

    The last paragraph sounds more like the considerations of someone raising livestock than of someone concerned with other humans. Believe it or not, people with IQs below 100 can lead normal and happy lives. Perhaps we should be a bit more reserved about making judgment as to whether some other person's life is worth living.

    Randall Parker said at July 25, 2005 12:04 PM:

    toot,

    Yes, an otherwise perfectly healthy and normal 90 IQ person can lead a fairly normal life. Though they are going to pay less in taxes per amount of benefits they receive. Also, they are more likely to get into car accidents, more likely to become criminals, and otherwise generate costs for the rest of us. IQ really does matter a great deal.

    What about the people with IQs below 85, with cerebral palsy, asthma, and assorted other disorders? Do you draw the line anywhere at all? Or just keep premie alive no matter the cost?

    Also, there is the point of who pays for it all. My guess is that most of the cost of low birth weight babies falls on the taxpayers, not on the parents of those babies. Well, should I be forced to pay for this?

    Fred said at July 25, 2005 3:46 PM:

    What about artificial wombs? A child is born prematurely then put in an artificial wombs until they are full term. (No such wombs yet but if they are perfected, this is one possibility.)

    Randall Parker said at July 25, 2005 4:22 PM:

    Fred,

    Do bother to read the entire post before commenting...

    Engineer-Poet said at July 25, 2005 4:48 PM:

    I read the bit about only 8% of severe premies being unable to walk without assistance and was horrified.  The rest of this litany is just more of the same.

    There are much worse things than death.  There is a time to intervene and a time to let nature take its course; if we can get these babies beyond their immediate crises but have no ability to give them everything that a normal child would have, we should reconsider our intervention (especially with the humanitarian cost of their pain).  In the past, these babies would not have lived; perhaps this is still the right thing.

    Toby said at July 25, 2005 5:09 PM:

    While I'm not necessarily disagreeing with you about the conclusions you implicity reach, I do disagree that any decision should be based upon an economic rationale. To imply that a human life is only worthwhile in terms of its contribution to the economy and that it is our primary duty to earn as much as possible in order to do so - which seem to be logical extrapolations from what you've said - lead to some rather chilling conclusions. That support for the aged is unnecessary. That a life in a country with a lower per capita GDP is worth less than one in a country in which it is higher. That potentially dangerous activities (such as rock climbing or skiing, for example) should be outlawed because of the risk they pose to an individual's earning potential.

    By all means argue that not providing life support to extremely premature babies is in the long run kinder to them and their parents; I personally think you're probably right, even though I suspect that as a parent a decision like that would tear me apart. It's an extremely large ethical dilemma, and it's something that needs to be discussed. However, to reduce everything to a dollar value and to attempt to make a decision based upon that is crass, and does not address the ethical and emotional dimensions of the situation.

    Mthson said at July 25, 2005 5:11 PM:

    Responding to Toot, it'd be inaccurate to conflate refraining from saving otherwise-terminal fetuses with taking away the life of people who have already gone through the struggle of developing personhood and the ability to comprehend their environment.

    Randall Parker said at July 25, 2005 5:33 PM:

    Toby,

    I do not find old people analogous because many of them have done a lot of work and saved money to support themselves in retirement.

    You state:

    To imply that a human life is only worthwhile in terms of its contribution to the economy and that it is our primary duty to earn as much as possible in order to do so

    Contributions? Look, some people give more than they get. Others get more than they give. Some balance out. For example, someone who rapes, murders, and robs and then spends 40 years in jail has taken a lot more than they have given. The prison at Rikers Island in NYC costs $47,000 per inmate per year.

    Some people have been net drains on the rest of us for their entire lives. We can't always predict who those people be. But what about the people who one can predict will be net drains? Do we have a moral obligation to spend money to keep them alive when they weigh 2 lbs and then to support them for the rest of their lives? Where exactly does this moral obligation come from?

    There are other considerations besides money to be sure. But I resent it when people tell me I shouldn't oppose the hit on my wallet when other people (not me) decide to spend my money to keep 2 lb babies alive.

    Engineer-Poet said at July 25, 2005 8:08 PM:

    Toby writes:

    I do disagree that any decision should be based upon an economic rationale.
    Let's shrink this problem to make it a little less nebulous.  You've got a family living on an island.  They make their living by growing a few crops and fishing, which takes much of their time.

    They have a baby which requires so much care that it interferes with their ability to feed themselves.  This child is unlikely to be able to contribute more than it eats.  Should they let it die, or should they risk everyone's life to do what they can for the baby?  Remember, you are basing your answer upon an economic rationale.

    Society at large is much bigger and much wealthier than this hypothetical situation, but the damage from misallocation of resources to lost causes is equally grave even if it is harder to see.

    jim moore said at July 25, 2005 8:34 PM:

    I think that the most humane policy option is to work to reduce the incident rate of premature birth. Making sure that every pregnant mother is in good health will pay for itself in the long run.

    Randall Parker said at July 25, 2005 9:12 PM:

    Jim Moore,

    Some premature births are caused by the same thing that causes probably a third or so of all pregnancies to spontaneously abort: lots of genetic defects in eggs and sperm. This can't be fixed. The spontaneous abortions and premature births (which can be seen as a type of spontaneous abortion at a later stage) are selection mechanisms to weed out defects. Modern medicine is trying to stop the weeding out of the defects.

    Another cause of birth defects and premies is drug and alcohol abuse. Well, unless you want to test all pregnant women periodically for such abuse and isolate them in institutions if they test positive I don't think we are going to get anywhere stopping this sort of thing. Though Barbara Harris's organization CRACK does pay drug addict women to get sterilized or Norplant to stop having babies. Still, the scale of her activities are too small for the size of the problem.

    Braddock said at July 26, 2005 4:54 AM:

    Artificial wombs would cure much of this problem. Couples would freeze several embryos and develop them selectively at the proper time for them. If one did not work out, they would have several in reserve. Developing a fetus in an artificial womb could be done at any time, and at virtually any maternal age and work situation. With natural birth, a woman is often at her last possible chance to have a child. By delaying childbearing, she has invested all her mothering potential in this one child. If it is undeveloped at birth it is still all she has.

    A lot of people make a living off the misfortunes of others. Neonatalogy is a special interest, full of medical and administrative professionals who will fight to keep things just as they are. These poorly functioning unfortunate children represent dollar signs to a lot of people out there in the rehabilitation and social services industries.

    Donald Schrader said at July 26, 2005 4:58 AM:

    Just a few notes:

    1. Only 9% of the population scores above IQ 120.
    2. As noted above, some premature birth is caused by factors that are damaging in themselves, not the mere lack of weight; i.e. drugs, alcohol
    3. The simple overview of the study does not mention any breakdown by gestational age, which strongly affects lung and brain development; nor by causes of the premature birth which would indicate things that could be possibly preventable, thus changing future statistics.
    4. On a personal note, my little girl was born almost exactly a year ago at 1 lb 9 oz but had enough gestational age that she did well and at present seems to be progressing pretty much normally in weight, alertness, activity, etc. We have high hopes for her, and, yes, parents of low weight babies will have strong feelings about this. Even had she not done well, she would have added much to our lives and we would do everything we could to make her life happy and productive.

    Half the human population, by definition, is under IQ 100, so please remember that those below average in IQ can still contribute more with dedication than an above average intellect that is lazy or foolish. Even those who do 'average or better' in school may not do as well later as those with troubles who strive harder or are given opportunities to work around their problems. Many contributions in the world have come from those who started out slowly, or died early. Be cautious when you advocate certain actions, for you will reap the long term results.

    cathy said at July 26, 2005 6:14 AM:

    Many couples in the developed world decide how many children they want and when they have that many, they don't have any more. In this situation, a couple that decides to use extraordinary measures to preserve the life of a very small preemie may in effect be denying life to the normal weight baby they could have. Which is fine with me, but either way, one child lives and one child doesn't.

    Brett said at July 26, 2005 7:49 AM:

    Just so I've got this straight, there might be a 1 in 5 chance that your baby will experience life-long problems, so don't do anything that could save their lives? What about the other 80% that turn out to be healthy? Are you kidding me? Let's be honest here, not taking these measures requires making a subjective judgement on what a life worth living looks like. I'll just pass on that, thanks, and let that child make the decision later on as an adult. Withholding care that could save a child's life is euthanasia.

    Braddock said at July 26, 2005 8:09 AM:

    No, Brett, there is at least a 3 in 5 chance the low weight baby will experience life-long problems, some of them quite severe. If you see human resources as unlimited there is no problem. If resources are limited and caring for the impaired limits the potential achievement for the unimpaired, eventually the people who are paying for the extraordinary care for low birth weight babies are going to start asking questions. The expense involved in this care is generally too high for most parents. Someone else is called upon to pay for all this.

    Randall Parker said at July 26, 2005 9:27 AM:

    Brett,

    Do read my posts more closely. The chances are a lot higher than 1 in 5. The 1 in 5 chance pertains to a particular condition. Look at the aggregates I quote in the bulleted excerpt. 64% had problems seeing, hearing, or communicating. 38% are retarded and I bet the average IQ is below 90. Some have cerebral palsy. Some have other medical conditions. I doubt that even 1 in 5 is perfectly healthy.

    My guess is that natural selection produced mechanisms for aborting most of these fetuses because chemical signals indicate that they are not going to turn out well. Keeping them alive basically defeats a quality control process produced by natural selection.

    Apocalypse said at July 26, 2005 9:35 AM:

    Only way I'd accept not offering life-support for such babies, is if it was somehow proven to a satisfying degree that human consciousness does not arise until a later period. Without that, not supporting them'd be akin to taking a human life which is unjustifiable for present day states.

    This does make one beg the question: do parents have the right to bring forth a human being such that he has a substantial possibility of having below/sub-human qualities? aka deaf, super-short-lifespan, retarded,illness, etc, etc(very sleepery slope, I'd say, which could if taken to the extreme condone careful gen mods so as to allow behavioral tuning and imprinting along with trait finetunning... think M.J.)... and eventually even human lvl traits may seem inadequate compared to greater possibilities. Or should the best possible conditions be insured when they become available(gen screen/modding, uber art womb), even if by force, even against the parents' will?

    Randall Parker said at July 26, 2005 9:38 AM:

    Braddock,

    I do not expect artificial wombs to produce the beneficial result you expect.

    Why? Because artificial wombs would prevent most of the early stage spontaneous abortions that now take place to discard defective fetuses. The artificial wombs would keep defective fetuses alive. People who share the sentiments of Donald Schrader and Brett would look at the defective fetuses in artificial wombs and proclaim they have to be kept alive at all costs. Or would Donald and Brett make an exception when artificial wombs get used?

    Most of those who think that abortion is morally wrong and who think that all premies should be kept alive no matter what condition are going to use artificial wombs to increase the percentage of initiated pregnancies that go full term. Among the "life begins at conception" faction the one third or so pregnancies that spontaneously abort would be kept alive in artificial wombs no matter what the condition of the fetus. Therefore at least among that section of the population that uses supernatural religious arguments against ending pregnancies I expect to see a large increase in defective babies as a result of the use of artificial wombs.

    The streets find their own uses for technology. Some of those uses are not what the original advocates of the technology intended or expected.

    Mr. Econotarian said at July 26, 2005 10:47 AM:

    My dogs are not very intelligent (compared with most people). They can't take care of themselves, and need daily attention. They earn no income, pay no taxes. They will probably only live to be 10. But I still love them, and are glad they are in my life.

    Randall Parker said at July 26, 2005 11:54 AM:

    Mr. Econotarian,

    At the risk of stating the obvious: Your dogs are not supported off the public purse. They don't go to elementary school where special ed teachers work with them in small classes. They don't receive Medicaid. They don't have behavioral problems (presumably) that cause them to beat up on other people.

    toot said at July 26, 2005 2:10 PM:

    Mthson,

    I understand the "investment" concept of personhood, though I can't say that I accept it. Regardless, I don't see how it applies to my comment. I accept that in the end it comes down to a question of how much we are willing to invest in an attempt to sustain a life, but I question whether the return on that investment should be measured on the basis of future societal contributions. The gift of life is bestowed by parents to the child, for the sake of the child, not as a means for improving their own standard of living. I understand that this has not always been the case in our own culture, and that it continues not to be the case in other cultures. But we have reached a point at which we can afford to look at these questions more humanely.

    Kurt said at July 26, 2005 3:03 PM:

    This is an interesting discussion thread. Although you cannot always reduce life down to dollars and cents, I have to admit that I agree with Randal Parker on this issue.

    The problem in our society is that the decision about what kind of child, or even to have children, is regarded as a private choice. However, the cost of raising that child is then regarded as a requirement on the part of the general public. This is an example of private choice but public responsibility for the outcome of that choice.

    It is this logical inconsistancy that is the problem here. Child choice and responsibility should either be an entirely private affair or an entirely public affair. You cannot make one part private and the other public. Randal is spot on here. If I am to assume the responsibility of paying for other people's kids as a tax payer, I feel that I am entitled to some input as to who gets to have kids and to what kind of kids those people have. This is only consistant and proper.

    Randall Parker said at July 26, 2005 3:04 PM:

    toot,

    "Our" culture? If I disagree with you on some moral question then am I a member of the same culture or imagined consensus that you point to in support of your position?

    You state:

    The gift of life is bestowed by parents to the child, for the sake of the child, not as a means for improving their own standard of living.

    I disagree with this. You can't bestow a gift on someone who doesn't exist yet. There is no one there to receive it. The act of creating the life create the thing you want to give the gift to.

    I also disagree that motives have changed. Women in particular want babies and this is a deep genetically programmed desire they seek to satisfy. Some men want to be proud about that chip off the old block they created. Reproduction is a selfish act.

    Eric said at July 26, 2005 3:15 PM:

    Just a note: I was under the impression that low birth weight can/does occur independently of premature birth.

    toot said at July 26, 2005 4:51 PM:

    Every society needs to replenish its population as the aged die off. (For the moment let us put aside our dreams of a "fountain of youth"). So, in a sense, you are right in that at the societal level we have devised such institutions as marriage and public schooling to assure that each generations is able to take over the tasks left open by the demise of its elders. I was speaking at the individual or family level when I suggested that the parents in effect give life as a gift to their offspring. I noted that individuals in our culture in the past, as well as in many other cultures, even today, regarded children as a kind of pension--a means for assuring there would be someone to support them when they had become decrepit with age, or as a means for gaining additional help around the shop or farm. I don't see how observing that this is the case in any way raises a question regarding Randall's place in our culture, particularly since he seems to continue to hold something approaching this view.

    Again, considering child rearing at the individual, or family, level, currently the cost of raising a child is very unlikely to be recovered within the family. That is why families have become small, rarely comprising more than parents and a couple children, and often no children at all. In an attempt to sustain the population profile required to maintain its way of life, society has instituted benefits to encourage child bearing, such as marriage benefits and public schooling. This helps to defray the cost. However, you are right to point out that the child bearing that still occurs is largely driven by natural urges, without which a species would drop out of the evolutionary picture. But these natural urges have other elements, as well, such as the urge to sustain, protect, and to rear the child that a couple has produced. I would be cautious about attempting to draw a line between children who "deserve to live" and those whose handicaps eliminate such a dessert, because once it is drawn, our society would be treating us more as slaves than as components or members.

    Randall Parker said at July 26, 2005 4:58 PM:

    Toot,

    Taxes are part-time slavery. Those of us currently working are forced to pay for the aged, handicapped, and criminal.

    While individuals have ceased to be a direct source of pension for their own parents they are a source of pension for all old people. We do this through government so that the relationship is not immediately obvious to anyone who does not want to see it. But the fundamental relationship between the generations is still there. We haven't escaped or advanced out of the dependency across generations.

    Children who are born very prematurely start out as a burden on all of society from the moment they are born. The vast majority of them will never (barring stem cell therapies and gene therapies) become net assets to society. We do have to pay for them. We do have to pay for the decisions that cause them to survive even though most of us have no say in those decisions.

    toot said at July 26, 2005 5:42 PM:

    Randall,

    We seem to be in agreemenrt regarding society's need to maintain a demographic profile so that, in particular, the aged can be sustained until they die of causes other than starvation. Your second paragraph says much the same as I had. We differ in regards to what is said in your third paragraph. Your view comes off, at least to me, sounding like the business ethics of Frank Perdue: "Keep alive only those whose continued existence adds to the profit." I would argue that this is too harsh to be acceptable at the level of individuals and families. Each couple has an emotional investment in the children that they give birth to, and it is such couples that society must entice, or at least make it at least economically tolerable, to have and raise babies. In your own words you recognize that many of the benefits of having children accrue to society, rather than directly to the parents.

    In the past the having of children was largely driven by the sexual urge. With the development of birth control technology and the societal acceptance of abortion, this is much less so than in the past. Now having children involves rather more subtle urges that can be more easily tempered by economical considerations. It is in society's interest to maintain a sustainable demographic profile. You are mistaken in looking upon the taxes that you pay for child education, etc., as a transfer of funds from you to the parents, for in fact, the return on the investment in a child accrues to society as a whole, while the bulk of the investment in him is made by the parents.

    Randall Parker said at July 26, 2005 9:26 PM:

    Toot,

    If I wasn't taxed to pay for the education of children then parents would spend more on child education. Therefore, yes, there is a transfer involved from me to parents. However, yes, the rest of us do get a return on investment in education for most people.

    But we do not get a return on investment for most births. Most people get more in benefits than they pay in taxes. Some people are massive net lifetime costs to the rest of us. This is more likely to be the case for some categories of births than for others. Very low birth weight babies are certainly a category where costs out weigh benefits a much larger fraction of the time.

    Heck, I've read claims that a majority of babies born in America today have the cost of their deliveries paid by taxpayers.

    toot said at July 27, 2005 8:02 AM:

    "But we do not get a return on investment for most births."

    I think you are confused here. Let us regard the taxes that are collected to be society's return on the investment on education, etc. Now only a fraction of the money collected in taxes is spent on education and other child related benefits. This is so even though the population is increasing (even if only through immigration). The remainder of the money collected pays for defense, space research, medical research and many other programs that I suspect that you favor. Consequently, there has to be a net gain on the investment in each generation.

    Now I concede that we could increase the gain from each generation by a merciless weeding out of the less productive, but keep in mind that many of those being weeded out are the children of loving parents who are not thinking in terms of maximizing the production efficiency of the herd. As long as we have of government "of the people, by the people for the people" the kinds of measures that you advocate would be intolerable.

    Randall Parker said at July 27, 2005 8:56 AM:

    Toot,

    As for what is politically possible: It is my understanding (about which I could be incorrect) that in many other Western democracies far less effort is made to keep alive very low birth weight babies. I've also read that many if not most countries do not classify very low birth weight babies as babies in their infant mortality statistics. So international comparisons if infant mortality rates are not comparisons of apples and apples.

    The United States is of course different from European countries in its average attitude toward many moral issues. But if more people knew how bad the outcomes are for very low birth weight babies mightn't more people decide that the extraordinary measures we now collectively finance for at least some of such babies to be unwise and unjustifiable?

    toot said at July 27, 2005 9:35 AM:

    Randall,

    Perhaps you are right. People can be convinced, often wrongly, that a potential handicap would make a life "not worth living". I have heard of cases of babies being aborted because they might be carriers of a gene for breast cancer or have a cleft palate. People sometimes deal with uncertainty in confused ways. I would hope that the information that you propose to make available would be accurate and somewhat charitable, so that parents are not presented with a deceptively bleak prognosis for their child. We are, after all, talking about the abandonment of a child to death.

    buffpilot said at July 27, 2005 10:09 AM:

    Randall,

    Your going down the slippery slope. If not the parents, WHO defines what is 'not acceptable' and thus will be aborted? Right now your talking premies. Then we talk Down's syndrome. Then the doctor says, 'Well mom & dad to be, your kid will have an IQ of 95, you can abort now and try again if you wish?" or worse the doc says, " According to government standards your child will have an IQ of 95 and will be aborted. You may try again in one month."

    And that's not even going into stuff like a 'gay' gene, looks, etc all of which will probably soon be available with genetic testing.

    Randall Parker said at July 27, 2005 1:25 PM:

    Toot,

    I have a few questions for you:

    1) Are you opposed to abortion?

    2) If so, do you think that at the moment of conception a child exists?

    3) If you think a child exists at the moment of conception do you think this is because the embryo gets a spirit assigned to it?

    4) Or do you come to this conclusion via a non-supernatural line of thinking such as that since an embryo can become a human that it must be a human, just not as developed?

    5) Suppose that technology could save all 1 lb premature babies but that all such babies would have IQs less than 85, cerebral palsy, and blindness. Do you think the existence of such technology creates a moral demand on us to use it to save these premies and take care of these premies for the rest of their lives? In other words, do you not see any relevance at all to the condition of fetuses and what they will develop into? Are their expected future handicaps irrelevant to your moral reasoning on this topic?

    Since I don't know whether a God or Gods or other supernatural entities exist I come at it from a biological viewpoint since it is all I can be sure of. I've read that somewhere on the order of a quarter or a third of all (and perhaps even more) successful fertilizations end as spontaneous abortions or premies that are not viable. This is a result of natural selection because it is a more efficient way to weed out genetic defects rather than develop some elaborate self test mechanism that would allow an egg and sperm to decide whether to even try to initiate a development.

    Basically, in my view nature is not a loving God who considers all spirits precious. Darwinian natural selection has produced a way of creating viable offspring that might seem brutal. Our attempt to go up against and defeat that mechanism in reproduction is partially defeating this mechanism but at a terrible short term and long term cost. This does not strike me as the equivalent of defeating microorganisms that kill us. We are tampering with natural selection in a way that produces horrible outcomes. I do not see this as humane and compassionate. It seems nuts to me. But I understand that the emotional design of the human mind is such (again for reasons of natural selection) that lots of people want to save these premies. And, believe it or not, I'm at peace with that just as I am at peace with the terrible costs of natural selection itself.

    Randall Parker said at July 27, 2005 1:35 PM:

    buffpilot,

    I'm going down a slippery slope? Look, technological advances created the slope. These premies all used to die a few decades ago. Currently 30% of them still die. If we do not labor mightily to develop technologies to save that 30% are we morally failing?

    Suppose we can develop technologies that will keep alive the 30% that now die. Suppose that all 30% will be grossly retarded and all sorts of misshapen. Should we keep them alive?

    We are interfering in natural processes with crude technologies and are producing a bunch of kids with cerebral palsy, retardation, blindess, deafness, and assorted other defects. Doesn't that bother you at all? Don't you question the wisdom of interfering in natural processes to produce such a tragic result?

    Just because we can do something that does not mean we should.

    Apocalypse said at July 27, 2005 7:04 PM:

    This be an interesting problem, I always try to appease those who base their beliefs in the supernatural, even though I may disagree with their points of view. I believe it's only possible to do this by coming to grips with regulated reproduction. By stopping defects before they even occur, for the most part. Yet many would oppose this... even though attempts at natural reproduction(often without the desire to reproduce only seeking physical pleasure) often result in the destruction of embryos, and even of full-blown babies.

    Attempts to reproduce via natural mechanisms worlwide result in mass destruction of embryos, and while this may not be significant to many, there are some for whom it is(yet amongst these, there are some groups who oppose anticonceptives). These attempts also often yield less than desirable outcomes when they do reach fruition. Often resulting in the loss of human babies, which most modern societies entitle the qualification of human.

    It seems that the most humane thing to do would be to limit the possibility of reproduction of the entire species, and use the most advance methods possible to select and engineer the few ideal progeny that would be brought into this world. But to do so would require extreme longevity, so as to not bring an end to the species itself... and enough power to quell the opposition. Power is concentrating, but will it reach such a stage when such a thing becomes possible?

    In any case, I've to look deeper into the issue, but without certainty of the presence or lack of consciousness given such a developed stage, I cannot recommend termination, as said. Especially taking into account the accel. rate of progress which may mean most anything may be treatable, and which may render most of society's present day rules and economic issues meaningless.

    Lei said at July 28, 2005 11:04 AM:

    But I understand that the emotional design of the human mind is such (again for reasons of natural selection) that lots of people want to save these premies. And, believe it or not, I'm at peace with that just as I am at peace with the terrible costs of natural selection itself.

    I think this is a key point. Logically, we all know that resources are limited and need to be rationed, but emotionally, none of us wants to deprive someone of help when they need it, least of all a helpless newborn.

    No matter how my toddler turns out and even if he is a total leech on society (oh, say it won't be so!), I will still love him and will fight for whatever he needs. That's what parents are supposed to do.

    RichardSharpe said at August 4, 2005 1:08 PM:

    Randall Parker says:


    There are other considerations besides money to be sure. But I resent it when people tell me I shouldn't oppose the hit on my wallet when other people (not me) decide to spend my money to keep 2 lb babies alive.

    But Randall, Governments waste far more money on other less justifiable (to my mind) things. Just look at Head Start and so on.

    Rather than suggest that maybe we shouldn't go all out to save low birth-weight babies, perhaps the financial burden should be placed on the parents ... let them make the decision based on an appreciation of the true cost to them.

    shanna said at October 6, 2005 10:12 AM:

    those stories are really sad if i could do something for those babies then i would its not the babies fault they came if i didnt want the baby i would have the baby then give it up at least it will understand what life is.

    Margaret Saunders said at October 19, 2005 2:03 PM:

    I am one of those low birth weight babies, i was born in the early fifties at under 2ib to an older mother that smoked, and was one of twins,the other of which died after a few days from birth.
    I suffer from deafness and bad eye sight, even having had a bleed behind one eye which resulted in urgent laser surgery.Added to that my I Q is not brillient, although i atended main stream school, i struggled.
    I cannot say i wish i had never been born but i wish my life had been easier and that i could not cope with a child with the problems i had and indeed my mother struggled to come to terms with mine.
    I also under took three attempts at I V F if any birth defects had shown up before birth, i know what choice i would had made. As it was all attempts failed, do other low birth weight people have fertility problems.
    Just a chance to let off steam -- thanks.
    regards
    52 year old.

    Mary Burnsed said at February 8, 2006 8:48 PM:

    My identical twin daughters, Morgan and Regan, were born at 1 lb 12 ounces and 1 lb 6 ounces. My husband is a physician and I am a registered nurse and elementary school teacher. Both girls have Cerebral Palsy; however, Morgan and Regan appear to be doing well, given the situation. Morgan had a stroke prior to being born and Regan has lung disease. The girls will do well in long-term. Both also have 2 million dollars worth of coverage (4 million total).

    Honestly, I can not imagine what my life would have been like had the girls died. My family would have never recovered from such a horrific thing.

    I must admit, I am truly freightened by what I am reading here. Randall, do you have children? Just curious. Once upon a time I thought just like you. Then my beautiful daughters came along and I had no choice. I thought if the girls did not have a good quality of life they shouldn't not be kept alive; however, there were other people who disagreed with me. I am sure glad they did. Do you realize that parents do not have the right to turn off life support in most of these cases? The hospitals/physicians are making those choices. Families are given very little support and they must assume full responsibility for their children. Trust me, I know this is true. As I have done it myself.

    You might want to rethink your position. I know plenty of children that were born "normal" and have been a burden to society, as you would put it.

    Mary Burnsed said at February 8, 2006 8:48 PM:

    My identical twin daughters, Morgan and Regan, were born at 1 lb 12 ounces and 1 lb 6 ounces. My husband is a physician and I am a registered nurse and elementary school teacher. Both girls have Cerebral Palsy; however, Morgan and Regan appear to be doing well, given the situation. Morgan had a stroke prior to being born and Regan has lung disease. The girls will do well in long-term. Both also have 2 million dollars worth of coverage (4 million total).

    Honestly, I can not imagine what my life would have been like had the girls died. My family would have never recovered from such a horrific thing.

    I must admit, I am truly freightened by what I am reading here. Randall, do you have children? Just curious. Once upon a time I thought just like you. Then my beautiful daughters came along and I had no choice. I thought if the girls did not have a good quality of life they shouldn't not be kept alive; however, there were other people who disagreed with me. I am sure glad they did. Do you realize that parents do not have the right to turn off life support in most of these cases? The hospitals/physicians are making those choices. Families are given very little support and they must assume full responsibility for their children. Trust me, I know this is true. As I have done it myself.

    You might want to rethink your position. I know plenty of children that were born "normal" and have been a burden to society, as you would put it.

    Steph said at February 22, 2006 10:31 PM:

    I just have one question for Mr. Randall Parker. If your savings should run dry when are "aged" as you put it, I am the young person who will be paying for your life with MY taxes. You sure wouldn't want me to be thinking of YOUR life in terms of dollars and cents from my wallet, would you?

    Steph said at February 22, 2006 10:33 PM:

    I just have one question for Mr. Randall Parker. If your savings should run dry when are "aged" as you put it, I am the young person who will be paying for your life with MY taxes. You sure wouldn't want me to be thinking of YOUR life in terms of dollars and cents from my wallet, would you?

    Kellie Taylor said at August 24, 2006 5:38 PM:

    I am a nursing student in Georgia and I am fascinating about some of your responses. We are actually working in groups in our Nursing Fundamentals class and one of our projects is to write an Ethical Paper on different topics, however, my group selected "Life-Support for Preemies" our Dilemma Title we chose is "Under What Circumstances. if any, Should Premature Babies Be Kept Alive on Life Support and Whom Should Decide"? Our Thesis for the paper is, "There are many ethical, social, economic, and legal issues that arise from prolong life in premature babies. The debate concerning whether premature babies should have prolonged life on life support, and who should have the final decision by the parent and health care professionals who provide care for them. With modern technology and under federal law, doctors can and must keep alive premature babies even if the parents want to let them die. Preemies may survive to grow up to have serious abnormalities that may later lead into long term disabilities. Should a life be based on technology and science in prolonging the lives of critically ill preemies, even though there is a small chance of recovery or survival in long term care and who should decide when to end a life?"

    If you would like to response to any questions listed above please do so by sending them to my email and if you don't mind, allowing me to share some of the responses in our paper. Thanks for taking the time to read my letter and can't wait to hear some of your replies.

    THanks,
    Kellie

    itsmethere said at February 7, 2007 12:17 PM:

    I am a 22 year old female. I was a low birth weight preemie (a 33 weeker, 3 lbs 15oz) born after a very prolonged labor in deep asphyxia (did not breath at birth) and needed 15 hours of mechanical ventilation. I do have spastic cerebral palsy, but walk without any aids.

    Yes, school was always hard for me(CP brain damage did cause some cognitive impairment) but I managed to get good grades in gen. ed. classes through excruciating effort, got a 1260 and then a 1350 on my SAT without any accomodations and am now completing a good college (barely coping but sticking it out).

    Yes, I did have a neuropsychological evaluation recently and my IQ profile is very uneven: my Verbal IQ is 135 and Performance IQ is 73 for a Full-Scale IQ of around 105. Uneven cognitive profiles are common in former preemies with CP.

    Yes, I will have more difficulties in life than most, but I am happy to be alive and believe that it was a right decision to save me.

    premie 1 said at February 20, 2007 9:14 AM:

    Hello Everyone,

    It really amazes me to sit here and listen to all of you talk about premies as though we are freaks at a circus or a drain on society. I was a premie- (2 lbs) and was in an incubator for 6 months until I reached the 5 lb mark. The doctors back then (1965) tried to talk my mother into aborting both my brother and I, but thank goodness she didn't listen to those idiots. (they also told her there was only 1 baby) -she knew otherwise and they would not listen.

    To cut to the chase- we both turned out perfectly fine and healthy. We both went to college and graduated at the top of our class and have rewarding, professional careers. The only problem here was that society tells you that your premie will not do well, and not to expect much from them, so the families of premies simply don't put the effort to try and give the child the idea that they can and will succeed. If the child isn't strong willed or stubborn enough to prove the family and society wrong- then the child will do poorly in school and not try to do as well as their classmates. "IF people do not expect much out of you- you will not expect much out of yourself" Premies get a bad rap- they do not strike out and hit people or act aggresively, most premies are very quiet and keep to themselves. Premies are actually very intelligent and caring people who contribute so much to our daily lives and "the economy", which seems to be a driving factor here. Premies should not be aborted or told that our lives are less valuable because we are smaller. Premies are tough and we go through more crapola before our six month mark than most people do in a lifetime. I think that shows how much fight we have in us. Most normal term babies would never survive what we go through and I think that shows what we're made of.

    SO for all the parents of premies out there... treat your premie like a regular child and expect nothing but the best from them. They will make you proud.


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