As a doctor in the neonatal ICU, there are things I have yet to come to terms with. These last few weeks in particular, I have had the unfortunate experience to be resuscitating both term and preterm moribund neonates. These babies were sick, ranging from severe congenital pneumonia that would desaturate almost instantly off the ventilator, even for a few seconds to simply adjust their position, to massive pulmonary haemorrhage in the preterm neonate just barely viable.
The thing that still bothers me, though, is the decision that must be made regarding doing the resuscitation as recommended, versus what actually happens.. the documented resuscitation. Basically what a documented resuscitation entails is doing the absolute minimum for the patient, sometimes nothing at all, but documenting the full resuscitation as per AAP guidelines to avoid legal consequences. Before you jump on the moral soapbox, understand that these babies were to die regardless. To prolong their life is to prolong their suffering, and even if pigs fly and the miracle recovery happens, the quality of life would be dismal at best. Severe cerebral palsy is no joke, and often leads to the family in a severe financial and emotional strain for decades to come, as well as for the health system. When the primary care giver cannot cope, the child is oft abandoned in some medical ward. In summary, you're dammed if you don't, and dammed if you do.
To compound the problem, our country does not yet have laws regarding euthanasia. Technical details regarding its application for neonates with a guarded prognosis should be a discussion the politicians, the common public and religious groups need to have a seat at the table and sort out.
Until then, however, seen in this light, the documented resuscitation would be a possible solution, avoiding the lifelong burden of caring for a child without any meaningful quality of life, as well as reducing the pain and distress the child will go through while being put through the paces of a neonatal intensive care.
My concern is that if we are doing the right thing, why does it feel so wrong? Ethics as I know it has different schools of thought. One definition of ethics is
what is right for the most amount of people. Which seems good on paper, but when it comes to decisions such as saving a 12 year old with healthy organs but needs an expensive procedure, versus letting 5 adults who needs those organs die because you decided to save the child instead, the lines get blurred. One side sides with letting the child die to save the others, while another side will choose to save the child and letting the others die. I feel like when it comes to dilemmas such as these, we are all just children trying to find their way in the dark.
We pat ourselves on the back as doctors and tell our colleagues that we are doing the right thing by pretending to push adrenaline while the parent watches their child die. Yet after we still go to our cars at the end of the day and sit in an empty parking lot staring at our steering wheel wondering why the oath of
doing no harm somehow gets broken every day..