By Mary Sanchez, Kansas City Star editorial page columnist

Guess which life may be more likely to receive heroic efforts to revive it: a premature infant, or an older patient with a lower chance of survival?

The answer — the older patient — surprised me.
But then again, my thinking is influenced by watching too many television series based on fake hospitals where every case is critical and high drama must unfold with each character admitted.

No doubt, society’s claim that all children are precious is also at play in my mind.
But recently published research, co-authored by a Kansas City doctor, proposes a disturbing finding that hospitals may inadvertently be placing differing values on the lives of patients, depending on whether they are a premature infant at the edge of viability, or an older patient.

The paper is an interesting look at the fact that infants at 24 weeks are considered “viable,” yet these babies still are often regarded as on the cusp of being a human being in that their personality or history with a family has yet to fully blossom.
Dr. John Lantos of Kansas City’s Center for Practical Bioethics co-authored the article published in the April edition of Acta Paediatrica.

Lantos noted it is as if extremely premature babies are placed in a “separate moral category.”

The paper points out statements by medical professional organizations saying all patients should be cared for by the same standard. Yet, the guidelines those same organizations put out do not follow suit.

Among other things, the paper argues that policies give too much weight to the gestational age of a premature infant in determining care, without thoroughly examining other factors. Estimates of gestational age can vary widely, especially when the child is conceived through in vitro fertilization, as is so often the case now with older mothers.
By contrast, the paper notes that no medical policies use the age of an elderly patient to determine the type of care, rather than individualized assessments.

Lantos and his three Canadian co-authors compared medical organizations’ policy statements addressing active intervention for newborns with guidelines for older patients.

“This article,” Lantos says, “is a way to throw down the gauntlet for individuals and institutions to examine how they treat babies at the edge of viability.”

Consider this example from the article:
A mother in preterm labor is admitted to a hospital. Her baby is estimated to be 23 weeks and five days, and about 650 grams in weight.
Note I use the term “baby.” Others might not, choosing the more clinical or reproductive rights-focused term of “fetus.”

A neonatologist following the American Academy of Pediatrics guidelines would give the baby’s parents a full run down of possible complications and ranges of survival rates, procedures that will likely need to be performed in the first few days after the birth.

Having fully informed the parents, the neonatologist might then offer the parents options; active intervention or what is termed “comfort care.”

Contrast this with the experience of parents whose three-year-old who was severely burned in a house fire. The child has smoke inhalation, thick burns on 85 percent of his body, mild hypotension.

The mother is told the child is critically ill and the toddler is immediately admitted to intensive care. After the child has a seizure, anti-convulsant medication is administered, to complement the other procedures that have already occurred. And, a chaplain is summoned.

In the burned child’s case, treatment was found to be likely to be “more painful, burdensome, and expensive.” And, the toddler had a worse prognosis for survival and long-term morbidity compared to the newborn.
Seated in the Lantos’s downtown office, the five-page paper offers a fascinating discussion of theory.

But for anyone who might face such moral decision-making — which could be anyone — the study is an important and challenging look at ethics today.

To reach Mary Sanchez call 816-234-4752 or send email to .