Thursday, August 18, 2016

Trisomy 13 and 18—Treatment Decisions in a Stable Gray Zone

In a new JAMA editorial, John Lantos shows that what was long framed a "futile" is really just a value judgment framed as a medical judgment.



"Thirty years ago, pediatric residents were taught that trisomy 13 and 18 were lethal congenital anomalies. Parents were told that these conditions were incompatible with life. There was a tacit consensus that life-sustaining treatment was not medically indicated. Clinical experience usually was consistent with this self-fulfilling prophecy."



"But with social media, this changed.  Parents share stories and videos, showing their happy 4 and 5 year old children with these conditions.  Survival, it turns out, is not as rare as once thought."  While median survival is just 12 days, 13% of children with trisomy 12 survive to 10 years.  And the "smile and laugh."



I am on the same page with Lantos and even with my frequent adversary Alex Schadenberg on this one.  


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