Will you live or will you die? The Struggle of Viability: Neonatal Nursing and Life or Death Decisions

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Albert Einstein once said “ ‘There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle’ ” (Dolezel, 2018). This brilliant genius was born two months early in Germany in March of 1879. For this time, neonatology was practically fictional and since then, neonatology has been working on improving issues as they appear one by one. One of these issues that has come up is the viability of babies. During past years, “Viability has been defined as sustaining life outside the womb, with or without medical assistance” (Nadroo, 2012). Neonatology is the medical care of newborns, especially newborns who are ill or premature. It is in a setting that occurs in hospitals called neonatal intensive care units (NICU). While attempting to provide the infant with ideal medical care while still supporting the family at the entrance of viability when delivery takes place, it is difficult to decide a solution to a concern regarding the child’s life. For those involved, such decisions may have permanent results. The people who are in the decision making process in the NICU include parents, family members, physicians, nurses, other health-care professionals and the hospital ethics committee (Nadroo, 2012). The best solution to fix the challenge of the viability of neonatal nursing is from a decision that everyone involved agrees on by looking at certain factors, and the principles of biomedical ethics to determine how successfully the infant will survive. Some of these factors are looking at how healthy the mother and the baby were during pregnancy, the decision-making process, the severity of the issues, Apgar score, and if their neonate has made progress. In other words, neonatal viability should be assessed in terms of gestational age, birth weight, and birth situation. Human viability has advanced throughout American History. Many versions of medical and legal definitions on social sustainability are out there. The law ignored abortion as a crime in the early 19th century. “Abortion was not encouraged, but it was linked to the portrayal of the viability of fetal movement in the womb of the mother…Although no minimum weight for viability was established, 1250 g was frequently used and corresponded to an estimated gestational age (EGA) of 28 weeks” (Arzuaga and Lee, 2011). Gestational age is used during pregnancy that is measured in weeks to illustrate how long the mother has been pregnant for. If a mother’s pregnancy reaches 38 to 42 weeks it is an expected solid term before giving birth. If a mother gives birth before 37 weeks the child is claimed to be premature. This addition of an infant’s gestational age was to help define viability supported in the mid-20th century. These definitions have been of gestational age, birth weight, or location within a hospital before. Another part that will undoubtedly impact some definitions of social viability could be the advance in technology. Most likely, human sustainability’s medical and legal definitions will continue to change from components that will emerge now or later. This definition means that as of now there is not a number one definition to define social viability. Doctors and medical professionals count on an Apgar test, which concludes with a score to further classify a baby as viable. This certain assessment should be the first physical indicator of a baby’s life. Once the baby has been out of the womb for a minute, the test is performed. The exact test is repeated after 5 minutes of the baby’s time here on earth. Fulfilling this test multiple times develops detailed information over the baby’s likelihood of surviving. Just like conducting an experiment, changing a step within the procedure can alter data. This is why it’s crucial to do the same test with no modifications. During the test, the observer (doctor, nurse) is scanning the muscle tone, reflexes, and skin color (Kaneshiro, 2016). Every one of these subjects is ranked with a 0, 1, or 2. Specifically, when considering a heart rate in any human being, it assists in determining if they are alive. Once an individual’s heart rate has remained at 0 “for at least 8 minutes they are labeled to be dead (Heller, 2017). Taking into account an infant logically speaking, undoubtedly will not come close to 8 minutes without breathing and still be alive. The score of the Apgar goes as high of a total of 10. The baby will be healthier when the result is closer to 10. Thus, any result above a 7 illustrates the baby’s viability is in a positive state. In some cases, a low Apgar score can frequently be produced by an unnatural birth, c-section, or fluid in the baby’s airway. Given that these circumstances are known in advance, doctors can arrange the necessary precautions. Once the provisions are enforced after the 1-minute test the baby will likely carry a normal Apgar status at the 5-minute validation. Although the score doesn’t outline the child’s well being for its whole life, it most certainly emphasizes the child’s chance of survival right after being born.Gestation at 40 weeks is how long pregnancies usually last. Viability is nothing lower than twenty-three weeks’ gestation. Twenty-three, weeks’ gestation is the cracking area, where many hospitals stop trying to help a baby that is born prematurely. However, this definition is unsecured. The cause for this is conception or being mindfulthat the dates may be off. Chances of survival for babies grows each week that the pregnancy continues. Babies that are born prematurely are placed into categories of gestational age and birth weight. These categories are restricted to being mild, moderate, or extreme. Namely, the longer, the baby is in the womb, the better the possibility is for the baby to thrive and live a life.Society commits the patient to allocate resources as necessary due to disability without discrimination. It is not reliable to make decisions shortly before or at birth. The results for these children can be affected in different ways by the recognition of their parents and members of the health care team. It is often urgent to rethink. Babies are still people, so they are legally entitled. Unfortunately, examples of resuscitating an extremely premature baby and suffering severe abnormalities have been found in the past. The physician failed to predict the result when the resolution was agreed on. The physician had to act when honoring the state law. The effect of having a disabled child was something that the parents had to handle. These results had responsibility for the parents that had feared for such a commitment. The parents didn’t consent to the medical health care that was provided. Incredibly, premature neonates may have to persevere through conditions that some may accept, but others may not accept. Parents should be aware of the child’s chances of survival and the possible outcomes. The hesitation begins with whether a child is considered viable, from which resuscitation and the necessary intensive medical care should be collected. For the rest of their lives, uncertainty about the outcome could and should affect both the parents and the infant. Be examined before resuscitation begins and the following care continues. Benefit and harm decisions reflect the views of parents, doctors, and nurses, influenced by personal values or experience.The variables for infant liveliness/results have changed significantly due to the advancement in technology. Not only have there been advances in technology for respiratory care but a more visible understanding of the role of a soap-like substance that has come across. Moving on with birth weight viability in the past has led to controversial discussions such as “ how small is too small?” and “ how young is too young?” It’s important to realize that various levels of NICUs identify specific challenges. Level 1 NICUs are just for the primary newborn health care of healthy infants. Nurses at level 1 can stabilize babies born in the near term to be transferred to a higher level of care. Level 2 NICUs provide support for babies to read and breathe. Babies may need mechanical ventilation and surgery for babies born at the lowest viability age at level 3 — level 4 care. Mechanical ventilation and surgical procedures, including open – heart surgery, are also performed. Even though there is advanced technology, babies still might not survive mainly in the higher-level NICUs.Williams and Magsumbol insist that the issue of viability for neonatology will invariably decline with coming up with a specific solution for the situation. They claim that ”The long-term prognosis for an extremely premature infant is frequently very poor, and the medical costs are enormous, the viability “gray zone”” for mandating care is ever decreasing”” (Williams and Magsumbol