Mary Dejevsky: Let nature take its course at 23 weeks

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If these were the figures for the efficacy of a new cancer drug, it would not stand a chance of being prescribed on the NHS, not even as a medicine of last resort. Only nine in 100 of those treated survive at all. Six of the nine live with severe impairments, while one – just one – goes on to enjoy a completely normal life. That's a success rate of 1 per cent.

Because it's four-month premature babies we're talking about, however, parental hopes, a pervasive pro-life bias and the simple "aahh" factor routinely push the decision the other way. Sorry to introduce so soon the callous matter of the balance sheet, but keeping these tiny babies alive for as long as possible costs the NHS – you and me – many millions a year. It's money that the science journalist, Adam Wishart, believes could be much better spent, not least on trying to reduce Britain's high rate of premature births.

He reaches his conclusion, slightly apologetically, at the end of a wrenching documentary to be shown on BBC2 tonight that considers babies born at 23 weeks. The survival chances of babies born at 24, 25 and 26 weeks have risen steadily over the years, but those of 23-weekers have hardly budged. They can be kept alive for longer, but the eventual outcomes have remained the same. Is this the limit of human viability? In the Netherlands, the answer is "yes". Below 23 weeks, doctors there "let nature take its course".

Wishart is scrupulously fair, sharing the agonies of often very young parents and showing the rare exceptions – the single 23-weeker in his six months at Birmingham Women's Hospital who becomes strong enough to go home (but may be brain-damaged), and a bright and lively 10-year-old who, it turns out, has benefited from intensive physiotherapy paid for by her doctor-parents. No, they insist, they would not have done anything any differently. Like the much younger and less educated parents Wishart met, they saw no choice. They baldly equate non-resuscitation with killing. This is not the message that comes from several of the senior doctors; nor from a nurse in the intensive care unit whose prematurely born and severely handicapped daughter is now 21 and the beneficiary of patchy help from social services. The daughter says, not unreasonably, "if you're willing to support someone at the beginning of life, you should be willing to support them to the end", which – she clearly believes – is not the case. The harsh reality is that more than 95 per cent of the time, expertise and money spent on the 23-weekers is essentially wasted. So why not follow the Dutch example?

Speaking warily, an NHS commissioner described the very suggestion as "a total no-go area", and said that she or anyone who made it would be subject to a witch-hunt. Alas, she's right; the internet chat-rooms are already hissing with vitriol about her contribution to 23 Weeks Babies. To my mind, though, the scandal is less that some medics want to challenge current orthodoxy, than that so many are cowed into silence. It's not just financial austerity that makes the wisdom of resuscitating very premature babies a discussion that needs to be had.





How to second-guess an octogenarian



From the earliest months of human life to the other extreme. Don't you think there are suddenly quite a lot of octogenarians around? If they were quietly taking cruises or enjoying their gardens, that would be fine; I wouldn't even mind them on Desert Island Discs. But no, here they are still wanting to run things.

We have Rupert Murdoch at 80, trying to buy back his one-time baby, BSkyB, as though he were entitled to a full century of media rule. We have Mikhail Gorbachev, 80 last week, criticising the duo running Russia, rather than basking in his historic achievement: dismantling the doomed Soviet empire without a civil war. And we have all those potentates from Tunisia via Arabia to Central Asia, quite a few of whom have still to recognise that time is finally passing them by.

It used to be that when a new foreign leader arrived on the scene, the Foreign Office would compile a chronology to show the formative events in that person's life – as a way of explaining how he (rarely she) might view the world. Perhaps someone should brush off those personal chronologies periodically, to remind us that the Murdochs of this world, the Mubaraks, the Gaddafis – and indeed, our own Queen – were forged in very different times. Understanding this better might make it easier to second-guess what they still want and how they might react to unforeseen and unwelcome events.





Equality on the roads? There is another way



The racily named Sheila's Wheels was one of the companies put on the spot by the European Court ruling that outlawed gender discrimination in car insurance. But I somehow doubt that many young men will see a reduction in their premiums; it's far more likely that young women will have to pay more.

The only predictable result is that higher premiums for young drivers generally will lead more to opt out altogether. As someone who has twice been hit by uninsured drivers, of whom there are around 2 million in Britain, I don't find this consoling.

Why don't insurers treat the ruling as an opportunity to alter the whole model of car insurance?

In France, novice drivers start on the same relatively low tariff, but the penalties for a claim are swingeing.

This is almost the opposite of our "no claims bonus" system. If lower initial premiums – rather than the £2,000 or so currently charged – brought more young drivers into the system, they would find it more difficult to escape the net later – and perhaps save the rest of us insured motorists some of the £1.2bn in extra premiums we have to stump up every year.

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