• DOI:10.1542/peds.2011-1689
• Corpus ID: 31065615

Limits of Human Viability in the United States: A Medicolegal Review

@article{Arzuaga2011LimitsOH,
  title={Limits of Human Viability in the United States: A Medicolegal Review},
  author={Bonnie H. Arzuaga and Ben H. Lee},
  journal={Pediatrics},
  year={2011},
  volume={128},
  pages={1047 - 1052}
}

• B. Arzuaga, Ben H. Lee
• Published 1 December 2011
• Medicine
• Pediatrics

Throughout American history, medical and legal definitions of human viability have evolved on interrelated but slightly different trajectories. In the early 19th century, although common law did not consider abortion to be a criminal offense, it was discouraged after the onset of quickening, which connected the initial delineation of viability to the sensation of fetal movement within the womb. When post–Civil War physicians campaigned to outlaw abortion, it was transformed into a criminal act, because societal attitudes had redefined human life as beginning at conception.1

In 1935, the American Academy of Pediatrics defined a premature infant as one who weighed <2500 g at birth regardless of gestational age,2 a standard first adopted in Europe in 1919.3 Although no minimum weight for viability was established, 1250 g was frequently used and corresponded to an estimated gestational age (EGA) of 28 weeks.2,4 In the mid-20th century, the addition of gestational age and crown-to-heel length to assist with the definition of viability was advocated.5,6

In the 1950s, infantile respiratory distress syndrome was described to the Royal College of Obstetricians and Gynaecologists of the United Kingdom7 and identified as a principal cause of death in infants younger than 37 weeks' EGA. This led to a landmark distinction between “premature” and “growth-restricted” infants who weighed <2500 g at birth.8 In the ensuing decades, neonatal mechanical ventilation and parenteral nutrition became established as contemporary cornerstones of neonatal medicine. Although the mortality rate of infants born at <1800 g was not significantly altered by initial intermittent positive-pressure ventilator strategies,9 the …

Address correspondence to Bonnie Hope Arzuaga, MD, Comer Children's Hospital at University of Chicago, 5721 S Maryland Ave, Chicago, IL 60637. E-mail: bonniehope{at}gmail.com