Watson A. Bowes, Jr., M.D.

Testimony before the House Judiciary Subcommittee on the Constitution

regarding the proposed legislation entitled Born Alive Infant Protection Act of 2001, HR 2175

July 12, 2001

Mr. Chairman and members of the committee:

My name is Watson A. Bowes Jr. I am professor emeritus of Obstetrics and Gynecology in the School of Medicine at the University of North Carolina at Chapel Hill. My medical school education and residency training in Obstetrics and Gynecology were at the University of Colorado Medical Center in Denver. I am board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. My major professional interest was in the care of women with high-risk pregnancies, especially those at risk of delivery of a premature infant.

From 1982 until June 20, 1999, I was a member of the full-time faculty of the University North Carolina at Chapel Hill. From 1984 until 1998 I was chairman of the Infant Care Review Committee at the University of North Carolina Hospitals. This interdisciplinary committee had the responsibility of developing guidelines regarding withholding or withdrawing medical care from seriously ill infants and reviewing any instance in which there was concern that these guidelines were not followed. Also from 1994 until 1999 I served on the Committee on Ethics of the American College of Obstetricians and Gynecologists and was Chairman of that committee during the last two years of that time.

My comments and opinions about are not made in behalf of the University North Carolina or any other organization.

I have read the legislation proposed in the Born Alive Infant Protection Act of 2001 which states that the criteria that an infant is born alive at any stage of development are that the infant "breaths or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles." This definition applies regardless of the duration of pregnancy at which the infant is born or the means by which it is born. This definition of live birth is consistent with that of the World Health Organization and is in current use by health department guidelines throughout most of the United States. Furthermore, these criteria of live birth are unambiguous and easily discernible by any birth attendant.

It is my opinion that this definition of being born alive does not and will not have a detrimental effect on either maternal or infant health care. I am confident of this because this is definition of live birth that is in effect in the state of North Carolina in which I practiced for 18 years. During this time, these criteria for defining live birth did not interfere with physicians making clinical judgments about providing appropriate care for newborn infants nor with parents being involved in those decisions. Importantly, this definition of live birth does not restrict a physician's prerogative to recommend that medical care regarded as futile be withheld or withdrawn.

It is important to keep in mind that this bill deals solely with the criteria that define whether an infant is alive at the time of birth. It does not legislate how physicians and parents may deal with the decisions about withholding or discontinuing medical or surgical treatment that is considered futile in the care of an infant. Providing life-sustaining treatment at the time of birth for infants in whom there is some doubt about whether they will survive allows physicians and parents the opportunity to discuss management options after more information is available about the infant's condition and prognosis.¹ A delivery room is not an optimum place for parents to make life and death decisions about their newborn infant. Of course, there are times when resuscitation of a depressed newly born infant is not successful. This bill does not require physicians to persist in treatment that is not successful or is considered futile.

Finally, in my role on the Infant Care Review Committee at University of North Carolina Hospitals, I was never aware of the egregious use or prolongation of futile medical interventions that could have been attributed to this definition of life birth.

Reference:

Kraybill EN. Ethical issues in the care of extremely low birth weight infants. Sem in Perinatol 1998;22:207-215.