Overtreatment of Neonates? A Personal Retrospective

Man's power over Nature is really the power of some men over other men, with Nature as their instrument. —C. S. Lewis The question of overtreatment of seriously compromised neonates with life-prolonging hardware is, in the end, a weighing of values—a moral judgment. The most pressing issues of our time, it has been said, are not matters of engineering, but of human values. And, didactic opinion to the contrary notwithstanding, I am prepared to argue that moral judgment is not monolithic. A system of values is not the same everywhere and for everyone. Nor is it an unchanging construct over time—even throughout one's own lifetime. Piaget,1 Kohlberg,2 and Rest3 have all made a strong case for the view that differences among people, in the way they evaluate moral problems, are determined, largely, by their concepts of fairness. A sense of right grows more discerning with age and is influenced by the amount and the complexity of social experience. Let me explain what I am getting at, by relating the growth of my own social experience as a rescuer of extremely small neonates. It began 47 years ago, when I was on the housestaff at The Babies Hospital in New York City. On January 27, 1945, a premature neonate was born in a small hospital in the Bronx, at 5½ months of gestation; birth weight was 600 g. The obstetrician was astounded that this extremely small girl breathed spontaneously and he was even more amazed to find her still alive the following day.