Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

• Published in: American journal of bioethics Vol. 20; no. 7; pp. 37 - 43
• Main Authors: Haward, Marlyse F., Janvier, Annie, Moore, Gregory P., Laventhal, Naomi, Fry, Jessica T., Lantos, John
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02.07.2020
• Subjects: Aged; Betacoronavirus; Bioethics; Coronavirus Infections - therapy; COVID-19; ethics; Female; Health care delivery; Humans; Infant, Extremely Premature; Infant, Newborn; justice; Male; neonatology; Pandemics - ethics; Pneumonia, Viral - therapy; rationing; Respiration, Artificial - ethics; SARS-CoV-2; Triage - ethics; COVID-19; justice; neonatology; ethics; rationing; Health care delivery
• ISSN: 1526-5161; 1536-0075
• DOI: 10.1080/15265161.2020.1764134

In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.