Prenatal testing and medical advances in treatment of very small preemies raise related ethical issues that are of life and death importance. CBS This Morning Health Contributor Dr. Bernadine Healy reports.
Some people ask how far medicine should go to save a tiny life. The question is a dilemma that every doctor and parent faces when it comes to a very premature infant, many of whom will have life-long disabilities if they live.
Is it fair to withhold treatment? This Morning's Dr. Healy thinks "That ethical dilemma is something that families and doctors face all of the time whenever you're talking about an end of life situation. It becomes especially problematic when dealing with an infant... They are helpless, the most vulnerable of all."
Under legislation passed in 1984, the circumstances under which treatment may be withheld from a baby are clearly defined. There are three circumstances, Dr. Healy explains: "One is if the child is basically irreversibly comatose, brain dead. Second, if you're prolonging their dying if it is futile. And the third is if the chance of survival is so slim that it is inhumane to subject them to aggressive treatment."
Prenatal testing leads to related ethical questions. We now have the ability to determine if a baby has Down Syndrome or other serious handicaps. "In this case the parents can get the information early, Dr. Healy notes, "and the mother alone can make the decision whether to terminate that pregnancy if [she is] uncomfortable with bringing a child into the world that has a serious handicap. The doctor and the state do not take a stand ethically on that issue."
Prenatal testing also reveals the baby's gender, Healy notes, but "for information only." She adds, "I don't know any doctor, and very few parents, who would abort a healthy baby because they didn't like the sex." Several countries, including Great Britain, have laws against aborting a healthy baby because of its gender.
The future for prenatal testing may be "treacherous," says Healy. Two kinds of genetic tests are on the horizon.
One tests for susceptibility to disease throughout the baby's future lifetime. For example, parents could find out what chance a baby will have of developing Alzheimer's disease when they are 80, or whether there's an increased chance of breast cancer or heart disease.
"Even worse, we may be able to have information on traits beyond gender," Healy says. "For example, height or skin color or hair color or eye color, or even intelligence or musical ability. Should a parent get involved in trying to select such babies before they are born? This is going to be a huge decision, not just for parents, not just for doctors, but for our society at large."
Prenatal testing can be a good ideeven if a family is against abortion under any circumstances, says Healy. "In some circumstances, prenatal testing can be useful in preparing a family, preparing a mother and father, for dealing with a child that may not be perfectly healthy." Knowing in advance a child's special needs can be useful for the doctor, as well as for the family and its support group.
A second testing technique is already at our doorsteps, although it's available only in a special case and it's expensive. Preimplantation genetic testing is available for couples planning to have in-vitro fertilization. Dr. Healy explains: "They take the embryo before it's implanted back into the mother. There is no pregnancy yet, and they can test one of the cells of that embryo and see if it has a genetic abnormality in cases like Tay-Sachs or even Down Syndrome. They can select the healthiest embryo to implant. And the couple doesn't have to struggle with the issue of whether to terminate a pregnancy which is already going on."
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