Lesson 6, Low Birthweight Infants
Overview of Lesson
- Courses for Which the Lesson is Intended
- Intended for middle school and junior high general
science classes.
- Types of Teaching/Learning Activities Employed in this
Lesson
- Students are given a handout to read as a homework
assignment, which contains factual information about low
birthweight infants. In the following class period students
are divided into cooperative learning groups. Each group
reads and responds to questions about a case study involving
the birth of a 14 ounce boy and the problems this presents to
various characters in the story. The entire class then
discusses the responses of each group. An additional set of
questions is presented for an optional follow-up class
discussion about the more general ethical problems presented
by children who are born with birth defects or special
needs.
- Category that Best Describes this Lesson
- Social Issues
- Ethics/Values Issues Raised by this Lesson
- Does society have the obligation to provide whatever
medical care and other aid is technically feasible to treat a
child born with a birth defect or other special needs,
regardless of cost?
- What are the ethical responsibilities of a family with
regard to such a child?
- What are the ethical responsibilities of other social
agents, such as medical insurers and employers with regard to
the birth of such a child?
- Should parents be legally libel for actions they have
taken, such as drinking, smoking or marital abuse that
increased the probability of the birth of a defective
child.
- Should a handicapped child have the right to sue parents
or institutions that failed to take actions to prevent or
treat his/her condition?
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Lesson Plan
Students should be given the following fact sheet to study
as a homework assignment in preparation for this ethics lesson.
To increase the likelihood that students will take this
assignment seriously, they can be told that a brief (five
minute) written quiz based on the fact sheet will be given at
the beginning of the lesson.
Facts About Low Birthweight Infants
- A low birthweight infant is any baby born weighing less
than 2500 grams (5.5 pounds).
- Low birthweight is the most common cause of serious
illness among newborn infants.
- Even with extraordinary care, low birthweight infants
live's are threatened by such problems as frequent brain
bleeds, inadequately developed lungs, poor body temperature
control and malfunctions of the liver.
- If they survive, low birthweight infants have a higher
than average likelihood of having such serious health
problems as birth defects, heart disease, mental
deficiencies, poor nervous system development and
susceptibility to infections.
- Smoking, drugs, poor nutrition and stress are all factors
that significantly increase a pregnant woman's chances of
having a low birthweight infant
- Intensive hospital care required by a low birthweight
baby typically exceeds $50,000.
- Care of the smallest babies, requiring the longest
hospitalization, can cost as much as $150,000.
- Low birthweight infants represent about 7% of the babies
born in the U.S. each year.
- Because they are likely to have disabilities children who
were low birthweight infants require greater than normal
community and school resources for their education.
- The yearly federal budget for the education of disabled
children is about $2 billion.
Students should be divided into cooperative learning groups
of three of four students. These groups should each be given
the case study to read and discuss, and questions to answer
(see below).
The teacher should lead the entire class in a discussion of
the answers recorded by the cooperative learning groups to each
of the questions.
If time permits, all, or part of the following class period
should be devoted to a teacher-led follow-up discussion of the
optional questions. The value of this session can be enhanced
by asking the students to prepare answers to some, or all of
these questions in advance, as a homework assignment.
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What To Do About Thomas? A Case Study
Cast of Characters:
Dr. Robert Fisher - Dr. Fischer, 46, is a pediatrician
(children's doctor) and an expert in the care of the newborn at
Public University Hospital. He has developed a new medical
procedure that has an 80% survival rate for extremely low
birthweight (under one pound) babies. Previously, using the
normal intensive care given to low birthweight infants, there
was almost no chance of survival for such tiny babies.
Unfortunately this new method is extremely expensive, costing
$450,000 per baby.
Joy Smith - Joy Smith, 30, is a clerk in the accounts
receivable for the Community Waste Management Corp. She is the
mother of one child (Susan, see below) and is and on March 9
she will complete the fifth month of her second pregnancy. This
pregnancy, like her first one has been difficult. She would
like to work until just before her due date, but back pains are
making it increasingly difficult to do her job. She has ignored
the advice of her obstetrician to give up smoking and social
drinking during her pregnancy because of the harm that these
habits can cause to her fetus.
Michael Smith - Michael Smith, 32, is married to Joy. He is
one of the most skilled machinists at Delta-Delta Electronics
and earns a base salary of $58,000 per year. Three years ago he
and his family moved into an attractive new four-bedroom home.
With the new mortgage and a second child on the way, which
means that his wife will not be working for at least two years
after the baby is born, he has been taking all the overtime
work that is available. He hopes that he and Joy will be able
to afford the college educations for their children that they
didn't have.
Susan Smith - Susan, 12, is in her first year at Middleville
Middle School. She has made a good adjustment to the new school
environment and has developed a large group of friends. She is
excited about the prospect of having a brother or sister after
years of wishing for a sibling. Susan is already in the school
band and the drama club. She also serves one period each day as
an assistant in the school library. This year she hopes to try
out for the Cheer Leader Squad. At home she has a nice large
room with her own TV, VCR and Stereo. She is trying to convince
her parents that she also needs her own phone. She has begun
thinking about college and would like to attend a good private
university like Cornell.
Dennis Copa - Dennis Copa, 49, is the owner of Delta-Delta
Electronics, a small sized, private company with 34 employees.
Increased competition in the electronics field has recently
reduced the company's profit. Sales of the company's most
successful consumer products have leveled off. The company lost
a recent bid for a government defense contract. Mr. Copa knows
that if he doesn't reduce the amount of expensive overtime work
he may have to lay off two or three of his employees. He is
also looking into negotiating a reduction in health benefits
with the employees union.
Joseph Sullivan - Joseph Sullivan, 58, has been the Chief
Executive Officer (CEO) of Mega Insurance Corporation for four
years. Mega has the contract to provide family health insurance
coverage to the workers at Delta -Delta Electronics. Partly due
to the increased cost of medical care, Mega's profits have been
decreasing for two years. Mr. Sullivan knows that if he doesn't
reverse this trend, the stockholders are not likely to retain
his services as CEO. He has already down-sized the payroll as
much as he can. One option he is looking into is declaring a
larger number of new medical procedures to be "experimental"
and therefore not eligible for coverage under the terms of the
company's insurance policies.
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The Action:
On February 27th Joy goes into premature labor
and gives birth to a baby boy at Public University Hospital.
Thomas weighs only 15 ounces. Joy had an easy delivery, is in
excellent health, but she and Michael are faced with some very
serious and troublesome decisions. They have been told about
Dr. Fischer's new procedure for extremely low birthweight
babies like Thomas. But they have also been informed that the
hospital's policy on low birthweight babies is that "unusual"
extreme care, such as that required by the Fischer procedure
will only be employed if it is covered by medical insurance, or
if the baby's parents agree to full financial responsibility.
Otherwise, Thomas will be put in the normal intensive care unit
for newborns, which means his chances of survival would be very
small. Michael contacts Mega Insurance Corp. and is told that
they consider Dr. Fischer's procedure to be experimental, and
not covered under his policy. The hospital informs the Smiths
that if Thomas is to receive the greatly enhanced survival
prospect of the Fischer procedure they will have to agree to
pay $300,000 -- the difference between the procedure's $450,000
cost and the maximum amount Mega will pay for intensive care
for newborns.
Joy and Michael have less than 24 hours to make a most
difficult decision. If they can somehow come up with $300,000
they can increase Thomas' chances of surviving for more than a
few days, from nearly zero to 80%. They also are told that even
if he does survive, the chances of him being a normal, healthy
child are less than 50%. He would have an increased risk of
having many serious ailments and a 25% chance of dying before
the age of 10.
The Smith's total savings amount to $20,000. Fortunately,
Joy has a rich uncle who she is sure would agree to help them
get a bank loan for the remaining $280,000. But meeting the
monthly payments will require a drastic reduction in the
family's lifestyle. Joy and Michael decide to involve Susan in
the decision. She is told that if they agree to the pay for the
Fischer treatment the family will have to sell their new home
and move into a much less expensive one in a less attractive
neighborhood. Susan will have a smaller room and she will soon
have to begin baby-sitting to pay for most of her entertainment
expenses. When she is 13 Susan will have to take care of Thomas
after school so that her mother can begin to work part time.
She will surely have to abandon the idea of having her own
phone and also of attending an expensive private college.
Michael also knows that before making a decision he will need
to confront Mr. Copa and try to persuade him to make an
exception and permit Michael to continue to earn at least as
much overtime pay as he has in the recent past.
Questions:
- Is it ethical for a hospital to provide a technically
feasible treatment only to those who can pay for it?
- Under the circumstances described, should Mega Insurance
be required to pay for The Fischer procedure?
- Does Dr. Fischer have any moral responsibility to try to
make his procedure available to those with limited financial
resources?
- Should everyone have equal medical insurance, or should
better policies be available to those who can afford
them.
- Is it fair for the Smiths to ask Susan's to help make a
decision that will have negative impacts on her?
- If you were the Smiths, what decision would you
make?
- If the Fischer treatment could provide a 100% guarantee
of Thomas surviving and living a full life as a normal
individual, would your answers to any of the preceding
questions be different?
- Should the Smith's take into account when making there
decision how they would feel if they agreed to pay for the
treatment and then Thomas either died, or became severely
handicapped?
- What moral responsibility should Susan feel for creating
this predicament, since her drinking and smoking increased
the chances that it would occur?
- If Thomas survives, but is severely handicapped, should
he have the right to either sue his mother for child abuse,
or to sue the hospital or his parents for treating him,
rather than letting him die?
Questions For Optional Follow-up Discussion:
- Using intensive care procedures on children who would
otherwise die results in larger numbers of retarded and
handicapped children. What is your response to this ethical
problem?
- Should decisions about whether to use expensive medical
techniques be based on some form of comparison of costs and
benefits?
- According to a U.S. Child Abuse law that went into effect
in 1984, all infants with disabilities are to receive
nutrition and other medically indicated treatment with three
exceptions
- the infant is in an irreversible coma,
- the treatment would only prolong dying and would not be
effective in treating the infant's life-threatening
condition.
- the treatment would be futile in terms of survival and
under such circumstances would be inhumane.
- Do you agree with this law? Do you think that it would
require a hospital to use an expensive experimental
method like the Fischer procedure in the case study on all
very low birthweight infants?
- Some obstetricians will not make a great effort to
resuscitate a severely handicapped newborn infant that
experiences heart arrest. Do you think this is ethical?
- Would it ever be ethical to withdraw treatment from an
infant with a poor chance of survival in order to provide
intensive care for an infant whose chances of surviving are
greater?
- Some medical policy makers have proposed that the public
funds that are now made available to provide intensive care
to infants with poor survival chances should be reduced in
order to provide more funds for prenatal care for women who
are at risk of giving birth to a low birthweight infant. What
do you think about this proposal?
- Wrongful life lawsuits brought against hospitals, doctors
and even parents involve a claim that a severely handicapped
child's life is worse than death or nonexistence. What is
your opinion about such lawsuits?
- Wrongful birth lawsuits involve claims against hospitals
or doctors by parents that a severely handicapped child was
born because of negligence on the part of the medical
personnel in denying them the opportunity for an abortion.
What is your opinion about such lawsuits?
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Discussion
Teachers report that the
student complaint "That isn't fair" is becoming increasingly
common. Frequently what the student means is that some personal
expectation or desire is not being met. This lesson provides an
excellent opportunity to get students to confront the
difficulty of meeting individual needs within the constraints
imposed by a society with limited resources.
As the students should learn from this lesson, the task of
developing necessary policies for prioritizing the allocation
of human, material or financial resources in an ethically fair
manner is extremely difficult. The rub is that there are
strongly held, sharp differences of opinion about what
constitutes a fair policy. For example, wealthy people will
generally favor a system that allows limited resources to be
purchased by anyone who can afford them, whereas poor people
will demand a system that distributes these resources in a
manner that provides equal access to people in all economic
strata.
These are issues that will become increasingly important as
rapid advances in biomedical technology continues to make it
feasible to devise healthcare options that can not possibly be
made available to everyone. Government officials in the Oregon
have already learned how divisive it can be to attempt to
define a scheme for rationing healthcare. Questions like
whether a kidney transplant should go first to the patient who
needs it most desperately, or to the one whose life is likely
to be prolonged the most, can not be answered in ways that will
be agreed to by everyone. All of today's students will be
choosing governmental officials who will be faced with the task
of achieving a political consensus on these vital, value-laden
questions.
Albert Coppola, Robert Frost Middle
School
Deer Park John Marr, West Hollow
Middle School
Melville Mary Kay Marr, Paul J.
Gelinas Jr. High School
Setauket Dennis O'Hara, Miller
Place High School, Miller Place
John Piropato, William T. Rogers Middle
School, Kings Park