Art and Julia Inskeep's new baby, Joshua, was born premature at 24 weeks of pregnancy. When they went to see him in the neonatal intensive care unit, they were not allowed to touch him. He was so small. His feet weren't even as big as a fingertip.

The doctors don't know what caused Julia to go into premature labor. But when Joshua was born, they told the Inskeeps that there had been successes in saving 24-week-old babies. With the newest machinery and techniques, the doctors said, the baby had a good chance of surviving.

Neonatologists, who study newborns, are concerned with outcomes. The more premature a baby, the worse its outcomes. A normal pregnancy length is 36 weeks, but babies have survived after being born as early as 23 weeks. The biggest problem is the lack of a substance called surfactant. This fatty substance coats the inner surface of the lungs and keeps them from collapsing. During its time in the uterus, the baby breathes fluid, and its oxygen comes from the mother's blood.

A number of advances are helping younger and younger babies survive. One is the development of a surfactant taken from calf fetuses. Another is a respirator called an oscillator. Instead of delivering the normal respiration rate of 30 breaths per minute, the oscillator gives 900 tiny puffs per minute. This keeps the baby's lungs constantly inflated, and oxygen seems to enter the bloodstream more efficiently.

The procedure, however, can be dangerous. The technology is usually used with babies who are at least 25 weeks developed; the less developed the baby, the more likely the occurrence of a brain bleed, which would cause brain damage and have other serious consequences.

The doctors have asked the Inskeeps to decide whether or not to have Joshua connected to the oscillator. Art and Julia have never had a more difficult decision.

1. What should the Inskeeps do?
2. What information do the Inskeeps need to make the decision? List four things.
3. A number of years ago, doctors would make this decision without consulting the parents. Give two reasons this might be wrong. Give two reasons this might be best.
4. If the doctors connect Joshua to the oscillator and he then dies, are there grounds for a malpractice suit? Why or why not?
5. If the doctors don't connect Joshua to the oscillator and he dies, are there grounds for a malpractice suit? Why or why not?
6. Sometimes next of kin must sign an informed consent form, by which they acknowledge that the doctor has told them certain information and that they agree to a certain procedure or medical plan. Whom does this protect?