Twenty-three and twenty-four weeks gestation are sometimes called the border of viability, because these are the earliest gestations where reasonable numbers of babies begin to survive. At 23 weeks the survival rate is about 30% and at 24 weeks it's 55 - 60%. Approximately one-quarter to one-third of those survivors will have a significant disability. Considering the survival and disability rates, many people think we should give parents the option of whether they want their baby resuscitated if born at those gestatioins. I don't have too much of a problem with that in a baby at 23 weeks gestation, but I personally find it hard not to resuscitate a 24 weeker. If a parent of a 24 weeker told me not to resuscitate her 24 weeker but rather let her die, I'm not sure I could respect those wishes.
I think we can all agree that at some gestational age all babies should be resuscitated and given life support (if necessary), regardless of the parents' wishes. For example, if parents of a 30 weeker - when the survival rate is greater than 95%, with most of the survivors without disability - said not to resuscitate their baby but let him die, just about everyone would agree that we should resuscitate that baby anyway. Similarly, if the parents of a 20 weeker - when there is no chance of survival - requested resuscitation, almost everyone would agree that it is acceptable for the neonatologist to refuse that request. But at what point in between does it become okay to not do as the parent wishes? Is it at 25 weeks, when the survival rate is 70%? Or 26 weeks, with a survival rate of 85%? At 27 weeks, with a rate of 88%?
Personally, I think it's tough to not resuscitate a baby when he or she has a 55 - 60% chance of survival, and I'm glad that in the population I work with nearly everyone wants everything possible done for their baby. (Most want everything done at 23 weeks, too.) As I mentioned in a previous post, if a, say, 10 year old had a disease with the same survival and disability chances of a 24 weeker, many people would want to call Protective Services to force treatment if the parents declined treatment. So what's the difference between that 10 year old and the 10 second old 24 weeker? The difference is age; it sounds like age discrimination to me if you'd allow no support for the baby but not for the older child.
This discussion can get hugely complicated; we haven't even mentioned things like quality of life for people with disabilities, or costs of treatment, both financial and emotional. I just think that sometimes we have to stick up for babies' rights.