Born-Alive Infants Protection Act of 2001, Public Law No. 107-207

The “Born-Alive Infants Protection Act of 2001” (H.R. 2175) became Public Law No. 107-207 on August 5, 2002. The purpose of this law is to establish that “infants who are born alive, at any stage in development (and regardless of the circumstances of their birth), are persons who are entitled to the protections of the law.” The legislation defines the term “person” to include “an infant who is completely expelled or extracted from his or her mother and who is alive, regardless of whether or not the infant’s development is believed to be, or is in fact, sufficient to permit long-term survival, and regardless of whether the infant survived an abortion.” Furthermore, the law defines an infant who is born alive as one who, “at any stage of development, is expelled from the mother’s body and displays any of several specific signs of life—breathing, a heartbeat, and/or definite movement of voluntary muscles.”

Although the report from the Committee on the Judiciary regarding H.R. 2175 contains a great deal of rhetoric and anecdotal testimony, the law does not proscribe medical care for newly born infants delivered at the limits of viability. The report specifically states that “H.R. 2175 would not mandate currently indicated.” The debate regarding the efficacy of providing medical care to premature infants below a certain weight or gestational age is clearly not relevant in the context of this law. According to the committee: “H.R. 2175 would not affect the applicable standard of care, but would only insure that all born-alive infants—regardless of their age and regardless of the circumstances of their birth—are treated as persons for purposes of Federal law.”

It is the opinion of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) Steering Committee that the Born-Alive Infants Protection Act of 2001 should not in any way affect the approach that physicians currently follow with respect to the extremely premature infant. Physicians should discuss treatment options with parents, preferably before the birth of the infant. Treatment plans should be based on currently available information and outcomes. Guidelines for developing such plans in collaboration with the parents have been published elsewhere.1–3 At the time of delivery, and regardless of the circumstances of the delivery, the medical condition and prognosis of the newly born infant should be assessed. At that point decisions about withholding or discontinuing medical treatment that is considered futile may be considered by the medical care providers in conjunction with the parents acting in the best interest of their child. Those newly born infants who are deemed appropriate to not resuscitate or to have medical support withdrawn should be treated with dignity and respect, and provided with “comfort care” measures.

American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee

Members
David Boyle, MD, FAAP Co-chair
Waldemar A Carlo, MD, FAAP Co-chair
Jay Goldsmith, MD, FAAP
Lou Halamek, MD, FAAP
Jeffrey Perlman, MB, ChB, FAAP
Thomas E. Wiswell, MD, FAAP

NRP Editor
John Kattwinkel, MD, FAAP

Liaison Representatives
William Engle, MD, FAAP
Jose´ Luis Gonzalez, MD, FACOG
Nalini Singhal, MD, FRCPC
Barbara Nightengale, RNC, MSN, NNP
Timothy Myers, BS, RRT

References

  1. Niermeyer S, Kattwinkel J, Van Reempts P, et al. International Guidelines for Neonatal Resuscitation: an Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Pediatrics. 2000;106(3). Available at www.pediatrics.org/cgi/content/full/106/3/e29
  2. MacDonald H and the Committee on Fetus and Newborn. Perinatal care at the threshold of viability. Pediatrics. 2002;110:1024–1027
  3. Kattiwnkel J. Textbook of Neonatal Resuscitation. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics/American Heart Association; 2000
Received for publication Jan 10, 2003: accepted Jan 10, 2003. Reprint request to (D.B.) Indiana University Medical Center, 699 West Dr, RR208, Indianapolis, IN 46202. PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Academy of Pediatrics