Intended for healthcare professionals

Views & Reviews Review

The cost of survival

BMJ 2010; 340 doi: (Published 12 January 2010) Cite this as: BMJ 2010;340:c99
  1. David C Taylor, emeritus professor of child and adolescent psychiatry, University of Manchester
  1. profdavidctaylor{at}

    A mother’s description of the effects of premature birth deepens our understanding of the consequences of the life and death decisions made by doctors, finds David C Taylor

    The chance of survival of babies weighing between 500 g and 600 g is “approximately 20%,” says the website of the Children’s Hospital of Philadelphia. The nature and quality of “survival” is not particularised in that text. But some of the possibilities are vividly described by Vicki Forman, whose tiny twins were “saved,” albeit briefly in the case of one of them. They were saved against her express wishes and better judgment because Californian law, while permitting abortion at 23 weeks, requires all liveborns of that gestational age to be afforded all means of care. This allows the state a one in five chance of adding at least one more Californian to the existing 37 million and at least one more human to the seven billion on the planet.

    But who “affords” this care? Does the state that required this action take financial and social responsibility for it? Do the medical and insurance industries provide free care under the law or in consequence of its treatment of infertility? This family, even though seeking help to conceive a child, were professionally well informed enough to plead against the proposed resuscitation of their twins. The financial costs of the consequent medical care—to …

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