Bioethics Blogs

Inside the Gray Zone: Reflections on Gautham Suresh’s Narrative Matters Essay

Note: This piece was written in collaboration with John Lantos, director of the Bioethics Center at Children’s Mercy Hospital.

“I just caution you that we don’t know what we don’t know.”

These words came from one of my senior faculty members at Children’s Mercy Hospital in Kansas City, Mo. The context and tone of her warning made me clench my teeth.  As a young neonatology fellow, I wanted to think that we did know.

But it turns out, the senior faculty member was right.  Her words may have been the most important lesson I’ve learned during my neonatology fellowship. When it comes to the most premature of babies, there is far more uncertainty than certainty. I have learned to recognize this, and believe that it is the key to being a good neonatologist.

In the October Health Affairs Narrative Matters Essay, Dr. Gautham Suresh recounts the tension that he experienced when resuscitating an infant at the borderline of viability. The essay raises the issues of parental decision making, the high rate of premature birth in the United States, and the always touchy issue of resource allocation.

In most health care centers in the United States, when an infant is born at the borderline of viability, typically 22-25 weeks of gestation, we ask the parents whether or not they want us to resuscitate the baby.  Theoretically, this approach makes sense.  In reality, however, parents are not really in a good position to make the decision.  They are emotionally stressed.  They don’t know the facts. They are dependent upon doctors to give them the facts, but these can be presented in ways that, intentionally or unintentionally, may lead the parents to a particular choice.  Parents make their decision in part based upon the information provided to them by the medical team.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.