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Nurses, physicians and hospice care for dying infants

March 28, 2004 -- Today the Santa Rosa (CA) Press Democrat ran a piece by Katy Hillenmeyer that does a fairly good job of highlighting Sonoma State University nursing professor Anita J. Catlin's prominent role in the debate over the care of terminal infants. Unfortunately, the article's frequent statements about what "doctors" do implies that only physicians provide significant care to critically ill infants, when nurses are central to such care, and its use of the "doctor" honorific for physicians but not nurses with doctorates is troubling.

The story focuses on the dilemma faced by family members and health professionals when a fetus or newborn is at the edge of viability and probably faces severe long term problems, but may be able to survive with the use of advanced technology. The basic message of Catlin and her colleague, Vanderbilt neonatologist Brian S. Carter, appears to be that the thousands of babies who will die despite aggressive, life-prolonging treatment should at least be offered the option of palliative care, since indiscriminate use of technology can lead to unnecessary suffering, as well as severe long term emotional and financial burdens on patients' families. Among the suggested reasons this has not been done traditionally are the apparent reluctance of many physicians to confront the issue with hopeful new parents and the lucrative nature of neonatal intensive care units. The story also provides some highlights from Catlin's career, and extensive discussion of her influential ideas by other professionals.

The article's descriptions of Catlin's achievements and its fairly balanced treatment of this critical debate are praiseworthy. However, we were troubled by its repeated references to what "doctors" can or should do for premature infants, with only one brief quote from a nurse who "manages [an] intensive care nursery"--which sounds more like day care than the high-tech, life-or-death environment it presumably is. The overall impression is that only physicians provide significant care to such infants, and perhaps that Catlin's expertise and interest is some kind of anomaly. In fact, nurses are central to the care of sick infants, particularly those who spend time in the neonatal intensive care unit (NICU), a highly nurse-intensive environment. We also wish the article would have referred to all those it described who have doctorates in a uniform way, rather than calling all the physicians "Dr. _____" but not doing so for Catlin and University of Alabama professor Marion E. Broome. This disparate treatment is especially glaring because the piece actually notes that Broome taught Catlin while Catlin was pursing her doctorate.

See Katy Hillenmeyer's article "Edge of Life: SSU professor in key role in debate over use of technology to rescue some premature infants" in the March 28, 2004 edition of the Press Democrat. Katy Hillenmeyer can be reached at khillenmeyer@pressdemocrat.com.

For a recent article on Dr. Catlin that provides a more in-depth account of the evolution of her views and the clinical and personal basis for them, Roseann Keegan's article "Local nurse honored for work with newborns" in the March 22, 2004 edition of the Napa Valley Register.

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