May 6, 2021
Born-Alive Abortion Survivors Protection Act
Testimony of Robin Pierucci, MD, MA
Mr. Chairman and members of the committee,
My name is Robin Pierucci and I represent the Charlotte Lozier Institute. As a neonatologist my job is to care for critically ill babies. After 20 years of practice in a 50 bed level III+ neonatal intensive care unit, I have not been able to medically solve every infant’s issues, but I also have not abandoned a baby who was born alive. Whether or not we can heal someone, there is always a duty to care. With regards specifically to caring for newborn infants, caring can be done in a number of ways:
One form of medically caring is to attempt to resuscitate the baby. The Neonatal Resuscitation Program (NRP) provides a consistent, research informed guideline for how to help a newborn baby transition from intra-uterine to extra-uterine life. Clearly, the more premature a baby is at birth, the more at risk they are for requiring significant help making this transition. However, the NRP’s algorithms are specifically designed to guide neonatal teams’ assessment and intervention for even our sickest and smallest babies. The NRP defines the medical standard of care that all live-born newborns are to receive; it defines the standard of care that all medical staff who regularly attend deliveries are responsible for providing.
In an adult emergency, resuscitation is assumed plan—if we miss the opportunity to resuscitate, death tends to be irreversible. In fact, in the adult world, one literally needs written permission through a “do not resuscitate” (DNR) order for physicians to have the medical, and legal permission to not resuscitate someone. The fact that it is currently legal to intentionally abandon an infant who is born alive is inconsistent with how we treat every other human being.
Resuscitation is the standard of care whether or not the live birth occurs in a hospital with or without an NICU, in an out-patient clinic, at home, the bus stop, a campground, or any other place that babies have been born. Because my hospital is the regional referral center for our area, over the years, we have sent our transport team out to some interesting places—and every place is not prepared to handle a term newborn, much less one who is premature or has other complications. While studies have demonstrated that extremely premature babies have better outcomes when born in a facility that routinely cares for their unique needs, we and other NICUs with transport programs throughout this country successfully transport babies into our units every day. Emergencies happen, that’s just one reason why we in the NICU and all critical care responders exist. No one guarantees the outcome; all of us guarantee that if called, we will show up. This is the medical standard of care that applies to all patients of all physicians. There are no ethical reasons why this medical standard should be abandoned for a subgroup of people because they might be less “wanted” than others; wantedness does not determine humanness. Put another way, it would be medically and ethically negligent if I only responded to the needs of babies who were born without any potential disabilities, or were planned, or had “normal” families. Wantedness does not determine if we have a right to live.
Importantly, caring for every baby does not mean every baby should be resuscitated. There are patients who are beyond our ability to heal. The NRP acknowledges this, stating:
“The birth of extremely premature babies and those with significant chromosomal abnormalities or congenital malformations frequently raises difficult questions about the initiation of resuscitation. … each situation is unique, and decision making should be individualized”
There is no one size fits all delivery plan, but at every delivery, the living person deserves to be assessed and extra help sought if those present are not sure what to do next. A living baby at every gestational age with or without obvious malformations, is a real human being; and just like every other patient, newborns need to be both skillfully and compassionately evaluated. As with every other age group of human beings, we err on the side of life, with a simultaneous awareness that there are times when keeping our patients safe and free from unnecessary pain or procedures that offer minimal benefit, may be the best “medicine”. Good medical care includes knowing when not to do a procedure. When an intervention or a procedure risks prolonging suffering, or having minimal benefit, there is no ethical or medical mandate to do it. This means a procedure, or a medical treatment can be futile or worthless, but those words do not ever describe a human being.
If you practice medicine long enough, you learn we get things wrong. Over the years I’ve seen well-meaning maternal fetal medicine doctors tell parents that the prenatal screening indicated there was an anomaly that was “incompatible with life”—and they were wrong. There is so much we cannot foretell until we actually meet and evaluate the baby. One mother of a child with trisomy 21 (Down’s Syndrome) came back to visit and show us how well her daughter was doing. She said to me, “everyone told me about the problems we should expect and how she would be different, but no one told me how much she would be the same as my other children.” Does such a child have any less of a right to live than another? Currently, abandonment of an adult or failure to evaluate a teenager, is not ethically, medically, or legally tenable; but if newly born, abandonment or intentional disregard are still legal.
For those babies who are too immature or have pathology beyond our ability to help, there is something called palliative care. Palliative care is not a euphemism for neglect until dead; perinatal palliative care is about helping a baby live well with a process we do not have the ability to heal. I have walked with parents through pregnancies, knowing there would be limits to what we could do for the baby. I have also walked into a delivery room where we discovered that things were definitely not right with the baby. But in both these scenarios, instead of hurrying death, with the aid of palliative care, when possible we took the time to confirm diagnoses, and then the families had the opportunity to meet their baby—with favorite music, and crazy aunts, siblings, and clergy. Photos and plaster imprints of tiny hands and feet were made. And about a zillion pictures were taken. One parent wrote me a letter describing how grateful they were that they actually took their baby home and had months together. That particular family’s baby was born alive, though we knew ahead of time that his life would potentially be limited. Therefore, given what we learned about him from ongoing care during the pregnancy, we agreed that we do parts of a normal resuscitation, but would not place him on a ventilator. We wanted to see if he would respond to simple interventions but did not want to use measures that a) wouldn’t solve anything, and b) would limit the family’s ability to hold him. It turned out that he responded beautifully to just a little blow by oxygen and then was able to be placed in his mother’s arms. We couldn’t cure that baby, but we could and did provide care.
In all of these cases, the first and primary diagnosis regardless of degree of prematurity or discovered abnormality is, it’s a baby. The other diagnoses one collects over a short or long lifetime never negate this first one. By this fact alone, every human being born alive deserves to be cared for. There are zero reasons to intentionally abandon a person, much less a baby. Mother Teresa stunned the entire world by picking up dying, disregarded people from the gutters of Calcutta and tending to them whether or not they could be cured. We too should never allow a baby, especially a baby, to die anywhere but in the warmth of our arms, nestled securely against our hearts.
Wantedness does not determine whether or not we are a human being. A physiologic diagnosis does not negate our humanness. We may choose to act only a little humanely, but we are never born only a little bit human. There is no one size fits all strategy for how much or how little to medically do for a newborn baby; but if born alive, we are always obligated to care.
I offer this testimony in the hope that by supporting a law that demands appropriate assessment and care for of all babies born alive, we will not only care better for the little one, we will simultaneously also better care for their mothers, which will extend to an entire family tree of affected loved ones.