The Miscarriage of Triage

Medicine is not a retrospective discipline; it is by nature progressive. Therefore, medicine requires intelligence, intuition, and compassion, and as such there is an abrasive blindness when a system of care becomes stagnant. Neonatal care is such a system: it demands that we indulge in its self-inflicted hyperbolic morality, without reasonably assessing its qualities and impact upon other wards. The infant ward frightens us and our resolution is to throw precious resources in its direction.

The amount of money allotted to neonatal care is eighty pounds a head. Since 2003, funding has risen periodically. This is vastly more than is allotted to other areas of care, such as trauma and injury; problems of vision and hearing; and skincare and organic poisoning. At ninety pounds a head, our interest in the neonatal ward rivals that of treating cancers- a far more prevalent collection of diseases that demand constant attention and research. The neonatal budget inevitably leads into the budget provided for sufferers of advanced disabilities and neurological damage, which stands at one hundred and twenty pounds a head- an amount larger than all other areas of medicine, except problems of circulation and mental health.

Neonatal healthcare is an area where less money could be allotted and the rate of success would remain largely at the same level. The intensive care given to infants is not a quick resolution of health problems that are advanced. Survivors often need intense care for their entire lives, corrective medicine and stalwart families. If this cannot be provided, a patient will experience great distress. I am not advocating the Spartan method of leaving the sickly infants by the hills – a foreseen right to life is surely one of the most compassionate pillars of society. Nevertheless: the neonatal wards are one of the wards where death is very frequent. Any saved money could instead be allocated to advanced neonatal research programs or more specialist institutes.

Palliative and elderly care are other wards where death is familiar and yet these wards suffer financial neglect. The only possible explanation of neonatal medicine being allotted more funding derives from that potential promise of future life. Regardless: biologically both types of patients are suffering from severe organic and nervous trauma. If a death occurs, there will be inevitable familial grief. The components are incredibly alike, and so that distinguishing feature which moves us must be our outrage with newborn mortality: that a life, so deserved, has already been challenged by a greedy and uncultured death.

This is a wonderful kind of outrage. To those who have persevered with the clinical attitude of this argument, it must be evident now that conclusions about these more tender areas of healthcare cannot be drawn from financial aerie. It is a gross approach to a multitudinous problem that does sometimes offer real success. It is also a gross simplification to approach this from a utilitarian perspective: without doubt, if we were to siphon the money away from neonatal care into care for trauma victims, or greater methods of cancer prevention, more patients could benefit securely than just the single infant, the promise of life waltzing around the neonatal ward with tragic whimsicality.

This is why medicine employs triage. This is the fundamental fault in neonatal care that hides behind our outrage and pretends to be fair. Triage exists everywhere: it dictates who paramedics treat first in large accidents; it dictates the spread of treatment in busy wards; and it is medicine’s compromise with utility: doctors and nurses can provide an equal and understandable service to all people. There is also an implied triage in healthcare budgets. The idea that neonatal care can rival treatment of cancer is preposterous, yet for almost a decade this is an established process. This is the only branch of medicine where hypothetical repercussions and emotional responses dictate the levels of care and resources given. An infant is still just a patient. To argue an infant is anything more is to demand the doctors and nurses treating one suddenly to become heroes. It is an undeniably tragic area of medicine, but it must conform to triage nonetheless. We have instead allowed neonatal care to inhabit an idealistic plateau, which in its superimposed ethicality, is unethical to all other medical pursuits.

In healthcare human life cannot be given a price, but the prioritisation of it is unavoidable. Neonatal medicine cannot be challenged by the twin horses of utility and budget – that chariot is far too callous. It instead needs to be accepted socially for what it is: a delusion that seduces taboo. It is not an efficient system of care and our tragic requirement to see it devoid of criticism and intuitive measures, damages other people. The resources and time allocated to the upkeep of neonatal medicine must, at some point, be siphoned into advanced research, institutes, and a more efficient medical system that listens to parents, hears our collective rage, but also acknowledges the limits of medical geography and the repercussions of over-zealous behaviour. Life is a right, but it cannot be imposed upon a vessel for Life’s sake. The disproportionate balance of priority in medical resources is both blindly unethical and wildly insane. Although neonatal care exists to provide the healthiest lives possible to infants, it does not warrant the cost of infringing on the healthcare of others.

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