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Williams Kelly Hornsby C. Williams Fournier Hornsby Wilson C. National League batting champions. Walker Cavarretta Musial H. Walker L. Walker Helton L. That is, specific requests for assistance, such as requests for lethal prescriptions or lethal injections, were predictors of requests being honored, while nonspecific requests were not predictors of requests being honored. Some patients were believed to be depressed at the time of their request, and although physicians did honor some The End of Life: Ethical Considerations 19 of these requests, they were less likely to honor a request if they knew the patient was depressed.

Further analysis of the survey data identified factors associated with a physician honoring a request for aid in dying for patients requesting a lethal injection and those requesting a prescription for a lethal dose of medication. For patients requesting a lethal injection, those with severe physical discomfort other than pain and patients with a life expectancy of less than one month were significantly more likely to have their request honored than patients without these characteristics.

For patients requesting a prescription for a lethal dose of medication, those with severe pain and severe physical discomfort other than pain were significantly more likely to have their request honored than patients without these characteristics. In both groups patients who were depressed at the time of their requests were less likely to have their requests honored than those who were not depressed.

Marijke C. Jansen-van der Weide, Bregje D. Onwuteaka-Philipsen, and Gerrit van der Wal published a study in that revealed characteristics of patients in the Netherlands who explicitly requested euthanasia or physician-assisted suicide between April and December Of the patients who had initially requested EAS, sixty-five died before EAS was administered, seventy-two died before a final decision was rendered, sixty-eight changed their mind and no longer wanted EAS, were refused, and had their requests carried out.

Physicians caring for patients in all five categories were reluctant to grant the EAS request in some cases. This doubt was prevalent across groups. Other common doubts expressed by physicians were those about the availability of alternative treatment, personal doubts in particular cases, doubts about the patient being depressed, and doubts about a well-considered and persistent request.

A factor shown in the table with a high OR was more likely than a factor with a lower OR to influence a physician to refuse a request for EAS. The table shows that the factor most likely to have influenced a physician to refuse an EAS request was the patient not being competent or fully competent did not have all of his or her mental faculties. The lower portion of the table shows that depression was the reason most likely to have influenced a patient to request EAS, while not wanting to burden their family was the second most influential factor. In the s and early s infectious communicable diseases such as influenza, tuberculosis, and diphtheria were the leading causes of death.

These have been replaced by chronic diseases; heart disease, cancer malignant neoplasms , and stroke cerebrovascular diseases were the three leading causes of death in See Table 4. In the age-adjusted death rate which accounts for changes in the age distribution of the population across time for heart disease was Together, these two diseases accounted for Deaths from heart disease have been decreasing since , while cancer mortality has been dropping only since Not surprisingly, the leading causes of death vary by age.

For those ages one to forty-four, accidents and their adverse effects were the leading causes of death in and , as well as the leading cause of death for those ages one to thirty-four in , , and For those ages thirty-five to forty-four, cancer was the leading cause of death in , , and , with accidents and their adverse effects second, and heart disease third. Cancer and heart disease caused most deaths among those forty-five years and older from to From to the number of cases increased and plateaued with slightly higher numbers of total deaths.

In the number of deaths from AIDS decreased. Most females contracted the virus by heterosexual contact or injection drug use. Children most often contracted the virus perinatally immediately before and after birth from infected mothers. This epidemic has brought a painful, drawn-out process of dying to many, including young adults—an age group previously relatively untouched by death, particularly from infectious disease. While hospitalization ensures that the benefits of modern medicine are readily available, many patients dread leaving the comfort of their homes and losing, to some extent, control over their end-of-life decisions.

Donna L. Hoyert, et al. Discussions and decisions about life-sustaining measures were observed. Death and Dying Death and Dying The End of Life: Medical Considerations 25 Accidents unintentional injuries Chronic lower respiratory diseases Cerebrovascular diseases Malignant neoplasms Diseases of heart All causes Cause of death and year Rates are based on populations enumerated as of April 1 for and estimated as of July 1 for all other years.

Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting.

Cumulative total includes persons of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total. It tested an intervention delivered by experienced nurses and lasted another two years, involving patient participants with characteristics similar to those in Phase I.

This time, however, the doctors were given printed reports about 28 The End of Life: Medical Considerations the patients and their wishes regarding life-sustaining treatments. To determine if the intervention worked in addressing problems in the care of seriously ill hospitalized patients at medical centers, researchers measured outcomes on five Death and Dying quantitative outcomes: incidence and timing of DNR orders; patient-physician agreement on CPR preferences; days in an intensive care unit in a comatose condition or receiving mechanical ventilation; pain; and hospital resource use.

The nurses supported patients and their families, brought them information, and helped them interpret it. Under normal conditions, when a patient suffers from a treatable illness, life support is a temporary measure used only until the body can function on its own. The ongoing debate about prolonging life-sustaining treatments concerns the incurably ill and permanently unconscious.

Death and Dying Cardiopulmonary Resuscitation Cardiopulmonary resuscitation CPR is composed of two basic life-support skills administered in the event of cardiac or respiratory arrest: artificial circulation and artificial respiration. Cardiac arrest may be caused by a heart attack, which is an interruption of blood flow to the heart muscle.

A coronary artery clogged with an accumulation of fatty deposits is a common cause of interrupted blood flow to the heart. Respiratory arrest, on the other hand, may be the result of an accident such as drowning, or the final stages of a pulmonary disease such as emphysema.

In CPR artificial circulation is accomplished by compressing the chest rhythmically to cause blood to flow sufficiently to give a person a chance for survival. It is important that CPR be done properly, or it may not be effective and may harm the victim. Heath care professionals may go beyond typical CPR procedures and deliver oxygen directly into the lungs through a tube inserted down the trachea windpipe.

Rarely, a tracheotomy is performed.

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In this procedure an opening is made in the windpipe through which a breathing tube is inserted. CPR, initially intended for healthy individuals who unexpectedly suffered heart stoppage, is now widely used in a variety of circumstances. Generally, following CPR, healthy people eventually resume normal lives.

The outcome is quite different, however, for patients in the final stages of a terminal illness. A person not wishing to be resuscitated in case of cardiac or respiratory arrest may ask a physician to write a DNR order on his or her chart. This written order instructs health care personnel not to initiate CPR, which can be very important because CPR is usually performed in an emergency. Note: This map refers to statutes that address DNR orders in the nonhospital setting only. Some of these statutes explicitly apply also to inpatient situations. However, most hospitals already have institutional policies regarding DNR orders, in compliance with the accreditation standards of the Joint Commission on Accreditation of Health Care Organizations.

Outside the hospital setting, such as at home, people who do not want CPR performed in case of an emergency can request a nonhospital DNR order from their physicians. See Figure 4.

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The DNR order may be on a bracelet, necklace, or a wallet card. Oxygen is supplied to the lungs through a tube inserted through the mouth or nose into the windpipe. Mechanical ventilation is generally used to temporarily maintain normal breathing in those who have been in serious accidents or who suffer from a serious illness, such as pneumonia. Today, a person who suffers cardiac or respiratory arrest is attached to a respirator after CPR has restarted Death and Dying the heart.

In some cases, if the patient needs ventilation indefinitely, the physician might perform a tracheotomy to open a hole in the neck for placement of the breathing tube in the windpipe. Even if a patient has irreversible brain damage, as long as the brain stem is functioning, the person is considered alive and the mechanical respirator cannot be withdrawn. Ventilators are also used on terminally ill patients.

In these cases the machine keeps the patient breathing but does nothing to cure the disease. Those preparing a living will are advised to give clear instructions about their desires regarding continued use of an artificial respirator that could prolong the process of dying. Artificial Nutrition and Hydration Artificial nutrition and hydration ANH is another modern-day technology that has further complicated the dying process.

Today, nutrients and fluids supplied intravenously or through a stomach or intestinal tube can indefinitely sustain the nutritional and hydration needs of comatose and terminally ill patients. ANH has a strong emotional impact because it relates to basic sustenance. In addition, the symbolism of feeding can be so powerful that families who know that their loved one would not want to be kept alive may still feel that not feeding is wrong.

However, appetite loss is common in dying patients and is not a significant contributor to their suffering. Moreover, evidence exists that avoiding ANH contributes to a more comfortable death. ANH has traditionally been used in end-of-life care when patients experience a loss of appetite and difficulty swallowing. Health care practitioners use ANH to prolong life, prevent aspiration pneumonia inflammation of the lungs due to inhaling food particles or fluid , maintain independence and physical function, and decrease suffering and discomfort. Furthermore, artificially delivered nutrition does not protect against aspiration and in some patient populations may actually increase the risk of aspiration and its complications.

The ADA suggests that the patient should determine the extent of his or her nutrition and hydration, and that shared decision making should occur between health care professionals and the family when the patient cannot make such decisions. Kidney Dialysis Kidney dialysis is a medical procedure by which a machine takes over the function of the kidneys in removing waste products from the blood. Dialysis can be used when an illness or injury temporarily impairs kidney function. It may also be used by patients with irreversibly damaged kidneys awaiting organ transplantation.

Kidney failure may also occur as an end-stage of a terminal illness. While dialysis may cleanse the body of waste products, it cannot cure the disease. People who wish to let their illness take its course may refuse dialysis. They will eventually lapse into a coma and die. Most people in a coma recover within a few days, but some do not. Figure 4. For some, their brain dies. That is, they irreversibly lose all cerebral and brainstem function. More typically, patients who do not recover quickly from a coma progress to a vegetative state.

Those in a vegetative state for one month are then referred to as being in a persistent vegetative state PVS , and after a longer period see Figure 4. As Table 2.

go here They do not respond to stimuli, understand language, or have control of bowel and bladder functions. This condition is called a minimally conscious state MCS. Table 4. Partial consciousness MCS means that perception is severely altered, but the patient shows an awareness of self or the environment and exhibits behaviors such as following simple commands and smiling or crying at appropriate times. Some patients emerge from a MCS and some remain in a minimally conscious state permanently. Another disorder of consciousness that rarely occurs after a coma is locked-in syndrome.

The patient with locked-in syndrome has full consciousness, but all the voluntary muscles of the body are paralyzed except usually for those that control vertical eye movement and blinking. Persons with locked-in syndrome communicate primarily with eye or eyelid movements. Giacino discusses implications for treatment of patients in both a vegetative and a minimally conscious state. Standard interventions include stretching exercises, skin care, nutritional supplementation, and pain management. In minimally conscious patients, functional communication systems and interaction should be established.

If the patient does not improve and the criteria for permanence of the condition are met, decisions must be made concerning changes in the level of care and whether life-sustaining treatment should be withdrawn. Some examples of qualifying purposeful behavior are Appropriate smiling or crying in response to the linguistic or visual content of emotional but not to neutral topics or stimuli Vocalizations or gestures that occur in direct response to the linguistic content of questions Reaching for objects that demonstrates a clear relationship between object location and direction of reach Touching or holding objects in a manner that accommodates the size and shape of the object Pursuit eye movement of sustained fixation that occurs in direct response to moving or salient stimuli SOURCE: Eelco F.

Chances of Recovery Giacino summarizes the consensus opinion of the major professional organizations in neurorehabilitation and neurology concerning, among other things, the prognosis of patients in a vegetative state VS. The article notes that the probability of recovery of consciousness from a vegetative state depends on the length of time a patient has been in this condition and whether it was brought on by traumatic injuries or by non-traumatic causes. Of those people with non-trauma-induced VS who do not begin recovery by three months, approximately half will die during the next nine months and the other half will remain in a VS.

No cases of recovery after six months in a non-trauma-induced VS have been documented. Once death is pronounced, the body is kept on mechanical support if possible to maintain the organs until it is determined whether the person will be a donor. There are some organ and tissue donations that can come from living people. For example, it is possible to lead a healthy life with only one of the two kidneys that humans are born with, so people with two health kidneys will sometimes donate one to someone in need.

Portions of the liver, lungs, and pancreas have also been transplanted out of a living donor, but this is less common. In most cases, living donors make their donations to help a family member or close friend. Organ transplantation has come a long way since the first kidney was transplanted from one identical twin to another in The organs that may be transplanted from people who have died are the heart, intestines, kidneys, liver, lungs, and pancreas.

Tissues that may be harvested for transfer include bone, cartilage, cornea, heart valves, pancreas islet cells, skin, tendons, and veins. Living persons may donate a kidney, parts of a lung or liver, or bone marrow. Typically, donated organs must be transplanted within six to forty-eight hours of harvest, while some tissue may be stored for future use. Soon after organ transplantation began, the demand for donor organs exceeded the supply. Today, organ transplant is an accepted medical treatment for end-stage illnesses.

It maintains data on all clinical organ transplants and distributes organ donor cards. In , 7, people died while awaiting a transplant because donor organs were not available for them. In this condition, brain function has permanently ceased, but the heart and lungs continue to function with the use of artificial life supports. Transplant center evaluates patient, adds name to waiting list, and transmits requests to OPTN.

OPTN adds patient to its waiting list. When suitable organ match is found, transplant center is notified. When suitable patient is found, recovery team is notified. Transplant team receives organ, performs transplant. Recovery team removes organ. Organ is transported to recipient transplant center. Data updated as of October Of the remainder, The remaining were multi-organ procedures, for a total of 25, transplants in , up from 22, in and 18, in I wish to give: any needed organs and tissues only the following organs and tissues: Donor Signature Date Witness Witness U.

People who wish to be donors should complete a donor card see Figure 4. Prospective donors should inform their family and physician of their decision. Notes: An organ that is divided into segments liver, lung, pancreas, intestine is counted once per transplant. Kidney-pancreas and heart-lung transplants are counted as one transplant. Other multiple organ transplants are counted only in the multiple organ row. In most organ donors whose cause of death was known died of a stroke Anoxia lack of oxygen was the cause of death of Death and Dying In the Consolidated Omnibus Budget Reconciliation Act PL 99— required all hospitals receiving federal funding to adopt procedures to identify potential organ donors and notify families of their option to donate.

The number of transplants using living donors may be different from the number of living donors. This is because there is a small number of multi-organ living donors and multiple donors for one transplant. For example, a living donor might donate a kidney and pancreas segment; or two living donors might each donate a lung lobe for one transplant procedure.

A donor of an organ divided into segments liver, lung, pancreas, intestine is counted only once for that organ. A donor of multiple organs is counted once for each organ recovered. Donors after cardiac death are included in the deceased donor counts as well and are counted separately on the last line. Under the new procedure, hospitals are required to report every death to the procurement organizations. To promote awareness of organ and tissue donation, Congress in authorized the Internal Revenue Service IRS to include organ and tissue donor information with federal tax refund checks.

In another effort to increase public support for organ donation, the U. Governors of many states began a variety of programs aimed at increasing public awareness of the lack of donor organs and honoring people who have chosen to become donors. Governors of at least nine states forged partnerships with local advocacy, medical, religious, and business groups to strengthen support for transplant programs.

None in category. Notes: Includes donors or organs recovered for transplant and not used, as well as those transplanted. Form changes on April 1, changed the way cause of death was calculated. Not all recovered organs are actually transplanted. Thompson in April Secretary Thompson called upon powerful alliances between employers and unions to promote donation. If no local patient needed the organ, it was then offered regionally, and last of all, nationally.

The government, however, wanted organs to be given to the sickest patients first, regardless of geographic location. We need a level playing field for all patients. The network fought the new rules for two years in favor of the system already in place, which was based on geography. When an A system based on need rather than location took effect in March , although the issue of precisely who would decide the allocation of organs remained unresolved until April , when the U. House of Representatives passed a proposal to restore decision making to UNOS, where it has remained.

Children are supposed to outlive their parents, not the other way around. And when a child comes into the world irreparably ill, what is a parent to do—insist on continuous medical intervention, hoping against hope that a miracle happens, or let nature take its course and allow the newborn to die? When a fiveyear-old child has painful, life-threatening disabilities, the parent is faced with a similar agonizing decision. But what if the ailing child is an adolescent who refuses further treatment for a terminal illness?

Does a parent honor that wish? Table 5. The data in these two tables differ slightly due to the use of different data sets. Advances in neonatology the medical subspecialty concerned with the care of newborns, especially those at risk , which date back to the s, have contributed to the huge drop in infant death rates.

Infants born prematurely or with low birth weights, who were once likely to die, now can survive life-threatening conditions because of the development of neonatal intensive care units NICUs. However, the improvements are not consistent for newborns of all races. Death and Dying African-American infants are more than twice as likely as white and Hispanic infants to die before their first birthday. In the national death rate for AfricanAmerican infants was In the national death rate for African-American infants was See Table 5. Additionally, the life expectancy at birth of AfricanAmerican babies is less than that of white babies: African-American babies born in had a life expectancy of Some of the more serious birth defects are anencephaly a condition in which most of the brain and spinal cord are missing , spina bifida a condition in which the spinal column does not close completely, leaving portions of the spinal cord exposed , and Down syndrome a condition in which babies are born with an extra copy of chromosome 21 in their cells, which results in anatomical and developmental problems, along with cognitive deficits.

According to the CDC, one in every thirty-three babies born in the United States each year have birth defects. Babies born with birth defects have a greater chance of illness and long-term disability than babies without birth defects. These five leading causes of infant mortality accounted for more than half Among African-American infants, such disorders were the leading cause of death Rates preceded by an asterisk are based on fewer than 50 deaths in the numerator. Rates not shown are based on fewer than 20 deaths in the numerator.

National linked files do not exist for — Data for additional years are available. The Foundation notes that birth defects are the leading cause of death for children younger than one year of age in the United States. A birth defect may be a structural defect, a deficiency of function, or a disease present at birth. Some birth defects are genetic—inherited abnormalities such as Tay-Sachs disease a fatal disease that generally affects children of Eastern European Jewish ancestry , or chromosomal irregularities such as Down syndrome. Other birth defects result from environmental factors— infections during pregnancy, such as rubella German measles , or drugs used by the pregnant woman.

Although the specific causes of many birth defects are unknown, scientists think that many result from a combination of genetic and environmental factors. Though many birth defects are impossible to prevent, some can be prevented, such as those caused by maternal alcohol and drug consumption during pregnancy. Two birth defects that have been the subject of considerable ethical debate are neural tube defects NTDs and permanent disabilities coupled with operable but lifethreatening factors. An example of the latter is Down syndrome, a genetic abnormality that causes mental retardation and, frequently, malformations of the heart or kidneys.

Neural Tube Defects Neural tube defects are abnormalities of the brain and spinal cord resulting from the failure of the neural tube to develop properly during early pregnancy. The neural tube Death and Dying is the embryonic nerve tissue that develops into the brain and the spinal cord. In the period —96, four thousand pregnancies were affected with NTDs. The number dropped to three thousand in — Thus, in , the U. Public Health Service recommended that all women capable of becoming pregnant consume four hundred micrograms of folic acid daily.

In addition, the U. Food and Drug Administration FDA mandated that as of January all enriched cereal grain products be fortified with folic acid. The two most common NTDs are anencephaly and spina bifida. Anencephalic infants die before birth in utero or stillborn or shortly thereafter.

The incidence of anencephaly dropped significantly from 0. The largest drop during that time period was from to Since then, the general trend has been downward. See Figure 5. Issues of brain death and organ donation sometimes surround anencephalic infants. Rates per 1, live births. Figures for are based on weighted data rounded to the nearest individual, so categories may not add to totals.

Rates for Hispanic origin should be interpreted with caution because of the inconsistencies between reporting Hispanic origin on birth and death certificates. Race and Hispanic origin are reported separately on both the birth and death certificate. Race categories are consistent with the Office of Management and Budget standards. The multiple-race data for these states were bridged to the single race categories of the Office of Management and Budget standards for comparability with other states.

Note: Data are subject to sampling or random variation. They decided to carry the fetus to term and donate her organs for transplantation. When baby Theresa was born, her parents asked for her to be declared brain dead. Baby Theresa died ten days later and her organs were not usable for transplant, having deteriorated as a result of oxygen deprivation. Some physicians and ethicists agree that even if anencephalic babies have a brain stem, they should be considered brain dead.

Lacking a functioning higher 44 Seriously Ill Children brain, these babies can feel nothing; they have no consciousness. Spina bifida defects range from mild to severe. Other people are concerned that anencephalic babies may be kept alive for the purpose of harvesting their organs for transplant at a later date.

Depending upon the amount of nerve tissue exposed, spina bifida defects range from minor developmental disabilities to paralysis. Before the advent of antibiotics in the s, most babies with severe spina bifida died soon after birth. With antibiotics and numerous medical advances, some of these newborns can be saved. The treatment of newborns with spina bifida can pose serious ethical problems.

Should an infant with a milder form of the disease be treated actively while another with severe defects is left untreated? In severe cases should the newborn be sedated and not be given nutrition and hydration until death occurs? Or should this seriously disabled infant be cared for while suffering from bladder and bowel malfunctions, infections, and paralysis? What if infants who have been left to die unexpectedly survive? Would they be more disabled than if they had been treated right away? The development of fetal surgery to correct spina bifida before birth added another dimension to the debate.

There are risks for both the mother and the fetus during and after fetal surgery, but techniques have improved since the first successful surgery of this type in In the study was ongoing. The NICHD predicts that by the year , routine diagnosis and treatment of congenital malformations by means of fetal surgery will be standard therapy for most disabling malformations that are currently treated in young infants.

In the United States the rates of spina bifida have been declining since , and, though there was a slight increase in the mids, the rates decreased from nearly 0. Age-adjusted death rates are per , U. Down Syndrome Down syndrome is a birth defect caused by chromosomal irregularities.

Instead of the normal forty-six chromosomes, Down syndrome newborns have an extra copy of chromosome 21, giving them a total of forty-seven chromosomes. The CDC estimates prevalence of Down syndrome at birth as approximately ten cases per ten thousand live births. The occurrence of this birth defect rises with increasing maternal age, with a marked increase seen in children of women over thirty-five years of age.

In the past babies born with Down syndrome were usually institutionalized. Many died in infancy. Today, with the help of modern medical care, children with Down syndrome are typically raised at home and attain adulthood, although their life expectancy is shorter than average approximately fifty-five years. Except for the most severe heart defects, many other malformations accompanying Down syndrome may be corrected by surgery. Depending on the degree of mental retardation, many people with Down syndrome are able to hold jobs and live independently.

Birth Defects Prevention Acts of and On April 21, , President Bill Clinton signed into law the Birth Defects Prevention Act PL — , Death and Dying which authorized a nationwide network of birth defects research and prevention programs and called for a nationwide information clearinghouse on birth defects. Developmental disabilities are conditions that impair day-to-day functioning, such as difficulties with communication, learning, behavior, and motor skills.

They are chronic conditions that initially appear in persons age eighteen years or younger. The NCBDDD works with state health departments, academic institutions, and other public health partners to monitor birth defects and developmental disabilities, as well as to support research to identify their causes or risk factors. In addition, the center develops strategies and promotes programs to prevent birth defects and developmental disabilities. Rates are per , live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals.

Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates. Rate All causes Congenital malformations, deformations and chromosomal abnormalities Disorders related to short gestation and low birth weight, not elsewhere classified Sudden infant death syndrome Newborn affected by maternal complications of pregnancy Newborn affected by complications of placenta, cord and membranes Accidents unintentional injuries Diseases of the circulatory system Respiratory distress of newborn Bacterial sepsis of newborn Neonatal hemorrhage All other causes 28, All causes Congenital malformations, deformations and chromosomal abnormalities Disorders related to short gestation and low birth weight, not elsewhere classified Sudden infant death syndrome Newborn affected by maternal complications of pregnancy Newborn affected by complications of placenta, cord and membranes Accidents unintentional injuries Diseases of the circulatory system Respiratory distress of newborn Neonatal hemorrhage Bacterial sepsis of newborn All other causes 18, Number Rate Includes races other than white and black.

Data are subject to sampling or random variation. The investigators linked data from two independent population-based surveillance systems to find out if major birth defects were associated with serious developmental disabilities. When compared with children who had no major birth defects, the prevalence of developmental disabilities among children with major birth defects was extremely high.

The researchers observed that conditions such as 46 Cause of death and age Total blackc a Non-Hispanic white Those born weighing less than fifteen hundred grams three pounds, four ounces have very low birth weight. Low birth weight may result from various causes, including premature birth, poor maternal nutrition, teen pregnancy, drug and alcohol use, smoking, or sexually transmitted diseases. In , 7. About 1. African-American mothers were about twice as likely as white and Hispanic mothers to have low-birth-weight babies Honeycutt, et al.

Like the proportion of low-birth-weight babies, the proportion of very-low-birth-weight babies has also been increasing since the s, although rates stabilized from the late s through The increase in low- and very-low-birth-weight babies during the s is attributed to the increase in the multiple birth rate. Babies born as part of a multiple birth are at much greater risk of low birth weight than babies born as a single birth. Prior to the s in the United States, the courts were supportive of biologic parents making decisions regarding the medical care of their newborns.

Parents often made these decisions in consultation with pediatricians. Medical advancements in the s, however, allowed for the survival of infants who would have not had a chance for survival prior to that time. Prematurity The usual length of human pregnancy is forty weeks. From Wikipedia, the free encyclopedia. This article is about the novel by Vladimir Nabokov. For other uses, see Lolita disambiguation. For the band, see Clare Quilty group. This article possibly contains original research. Please improve it by verifying the claims made and adding inline citations.

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