Live and Let Die

Proponents of single-payer systems (read Socialized Medicine) frequenty cite infant mortality rates to demonstrate the alleged deficiencies in our healthcare system vs. other industrialized countries. Statistics don’t lie, but people reporting and citing numbers often do. Because other countries have very different standards for counting and reporting live births, apples-to-oranges comparisons present a skewed and dangerously misleading impression.

In a 2005 piece titled Infant-Mortality Myths, physicians Michael Arnold Glueckand Robert J. Cihak explain:

According to the World Health Organization (WHO) definition, all babies showing any signs of life – such as muscle activity, a gasp for breath or a heartbeat – should be counted as a live birth. The U.S. strictly follows this definition. But many other countries do not.

Switzerland doesn’t count the death of very small babies, less than 30 centimeters (11.8 inches) in length, as a live birth, according to Nicholas Eberstadt, a former visiting fellow at Harvard’s Center for Population and Developmental Studies. So comparing the 1998 infant mortality rates for Switzerland and the U.S. (4.8 and 7.2,respectively, per 1,000 live births) is comparing apples and oranges.

In other countries, such as Italy, definitions vary depending on where you are in the country.

Eberstadt notes “underreporting also seems apparent in the proportion of infant deaths different countries report for the first 24 hours after birth. In Australia, Canada and the United States, over one-third of all infant deaths are reported to take place in the first day.”

In contrast, “Less than one-sixth of France’s infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths.”

As UNICEF has noted, “Under the Soviet-era definition … infants who are born at less than 28 weeks, weighing less than 1,000 grams [35.3 ounces] or measuring less than 35 centimeters [13.8 inches] are not counted as live births if they die within seven days. This Soviet definition still predominates in many [formerly Soviet] countries. … The communist system stressed the need to keep infant mortality low, and hospitals and medical staff faced penalties if they reported increases. As a result, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths.”

The point about how medical statistics are politicized in Communist countries is not just a historical footnote. In that island paradise celebrated by Michael Moore, the Congressional Black Caucus, Dan Rather, and countless Hollywood celebrities, Cuban doctors are forced to abort babies with prenatal defects. Most of these abortions are done without the mother’s consent and often without their knowledge. As you read this, take a moment to think of a courageous black physician named Dr. Oscar Elias Biscet, who is currently serving a 25-year term in a Cuban prison for refusing to participate in forced abortions, putting the lives of his patients ahead of Cuba’s precious infant mortality statistics.

Considering the devastation wrought by 50 years of Communism, we must concede that Cuban infant mortality stats look pretty good. As they should since they exclude infants deliberately killed in order to inflate those stats. Killing defectives also cuts costs. Jeremy Bentham would approve. The greatest good for the greatest number. Well not exactly, but certainly the greatest good for El Numero Uno.

A more helpful indicator of the quality of neo-natal care is survival chances of very premature, very low birth-weight babies:

American advances in medical treatment now make it possible to save babies who would have surely died only a few decades ago. Until recently, very low birth-weight babies – less than 3 pounds – almost always died. Now, some of these babies survive. While such vulnerable babies may live with advanced medical assistance and technology, low birth-weight babies (weighing less than 5.5 pounds) recently had an infant mortality rate 20 times higher than heavier babies, according to WHO. Ironically, U.S. doctors’ ability to save babies’ lives causes higher infant mortality numbers here than would be the case with less advanced treatment.

This week, the Daily Mail reported the heart-wrenching story of Sarah Capewell and her son Jayden . Born prematurely at 21 weeks and 5 days, Jayden was breathing on his own, had a strong heartbeat and was moving his arms and legs, but his British doctors refused to care for him because of medical guidelines endorsed by the British Association of Perinatal Medicine and followed by NHS hospitals.

Guidance limiting care of the most premature babies provoked outrage when it was published three years ago.

Experts on medical ethics advised doctors not to resuscitate babies born before 23 weeks in the womb, stating that it was not in the child’s ‘best interests’.

The guidelines said: ‘If gestational age is certain and less than 23+0 (i.e at 22 weeks) it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out.’
Medical intervention would be given for a child born between 22 and 23 weeks only if the parents requested it and only after discussion about likely outcomes.

The rules were endorsed by the British Association of Perinatal Medicine and are followed by NHS hospitals.
The association said they were not meant to be a ‘set of instructions’, but doctors regard them as the best available advice on the treatment of premature babies.

In the US, Jayden would have been given every chance to survive. In fact, just a few weeks before the guidelines were published, a baby in the U.S. named Amillia Taylor, who was born prematurely at 21 weeks 6 days, nonetheless received medical care and is alive and healthy today.

Advances in medicine and technology make it possible for very low birth-weight premature babies to survive in cases that were unimaginable even a few years ago. You won’t know until you try the saying goes, but the 2006 guidelines drawn up by a faceless group called the Nuffield Council on Bioethics would not let Jayden’s doctors try to save Jayden’s life. All because Jayden had the temerity to be born 48 hours before the guidelines said he should.

I’m sure the experts in bioethics on the Nuffield Council would bristle at the suggestion that they constitute a Death Panel, but their utilitarian calculus, meticulously applied by the callous clinicians at James Paget Hospital in Norfolk, who denied responsibility using a variant of the Nuremberg defense (“We were only following guidelines”), meted out a de facto death sentence on Jayden. Because he was born 48 hours too soon. Perhaps their efforts would have been for naught. Perhaps he would have died anyway. We’ll never know. During her labor, Sarah Capewell desperately begged a pediatrician “You have got to help,” to which he replied, “No, we don’t.”

Limiting available healthcare options to whatever level of medicine is currently feasible will likely ensure that future medical advances are less likely to occur. There’s a reason why the US leads the world in R&D for life-saving prescription drugs and countries that ration healthcare do not. That’s the pragmatic argument. For me, the more compelling reason is the harm to our souls when we ignore the transcendent univeral moral code written in our hearts. If the human soul and moral law do not exist, then my argument is meaningless. But if they do exist, then we are literally playing with fire. In stifling the natural human tendency to show even minimal compassion for a distraught mother and her infant, we lay the groundwork for an inhumane system that values statistics and views people as numbers.

Woody Allen once quipped that 80 percent of success is just showing up. One never knows until one tries whether our efforts will make a difference, but I’d say 80 percent of making a difference is in the trying.

Jayden’s doctors didn’t even try. Shame on them.


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