Vitamin K: Do we have an ethical obligation to babies whose parents suffer healthcare delusions?

distraught looking conspiracy believer in suit with aluminum foil head isolated on white background

Vitamin K refusal is in the news again.

According to WBUR:

The baby was born full-term and healthy, but now, just a few weeks later, lay limp and unresponsive, barely breathing…

“The baby was diagnosed with bleeding in the brain,” said Dr. Ivana Culic, a neonatologist …

… The parents of the baby had refused the standard shot of Vitamin K that would almost certainly have prevented that bleed.

Tragedies like these raise a thorny ethical issue: how do we protect children whose parents suffer from healthcare delusions?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]You can’t take your baby home without a car seat; you shouldn’t be allowed to take your baby home without a vitamin K shot.[/pullquote]

Why is Vitamin K important?

Infants are vulnerable to a condition known as hemorrhagic disease of the newborn. The cause is deficiency of Vitamin K, an important component of the cascade of reactions needed for proper blood clotting.

As explained in this Medscape article:

Classic vitamin K deficiency bleeding usually occurs after 24 hours and as late as the first week of life. Classic vitamin K deficiency bleeding is observed in infants who have not received prophylactic vitamin K at birth.

The incidence of classic vitamin K deficiency bleeding ranges from 0.25-1.7 cases per 100 births…

Infants who have classic vitamin K deficiency bleeding are often ill, have delayed feeding, or both. Bleeding commonly occurs in the umbilicus, GI tract (ie, melena), skin, nose, surgical sites (ie, circumcision), and, uncommonly, in the brain.

There are approximately 4 million infants born in the US each year. In the absence of prophylactic Vitamin K shots routinely given to newborns, we would expect anywhere from 10,000 – 65,000+ cases per year. Routine vitamin K shots are literally life saving.

Sadly, some US parents embrace the fashionable delusion that vitamin K injections are harmful. It is their babies who suffer major GI and brain bleeds and the permanent injuries and deaths that go along with them.

Consider Baby Olive. Olive had been normal at birth and for the first few days afterward. Then her mother noted that she was lethargic. She immediately took Olive to the emergency room.

The next thing I knew I was sitting in a room with Eric and our Bishop from church, and seeing the doctor wheel in a computer with pictures on the screen… Just by looking, you could tell it wasn’t good. Where the left side of her brain was supposed to be, there was a huge (16 mm, to be exact) mass of blood, pushing her entire brain off center.

Dr. M. explain that a clot had developed which was placing immense pressure on Olive’s brain. Not only that, but there was bleeding on the back of the right side of her brain as well. The water pockets that are within the brain were completely destroyed, and the tissue on the left side of the brain looked mostly damaged. He said that the lack of Vitamin K in Olive’s system resulted in her body’s inability to clot. Anything as small as putting her down in her bed could have caused this bleed. Since she couldn’t clot, the bleeding didn’t stop. There had been one other case of this that the doctor had seen – I asked what had happened then, and was told that the baby hadn’t lived.

Olive was treated with vitamin K to restore the ability of her blood to clot and underwent brain surgery to evacuate the blood in her head; she made an excellent recovery. The entire disaster could have been avoided had Olive simply received vitamin K at birth.

As a general matter, we give parents wide latitude in determining the care and best interests of their children; we should! The freedom to raise your children as you wish is a critical freedom. But I would argue that we also have ethical obligations to babies like Olive whose parents embrace fashionable healthcare delusions.

Parents are free to risk their own lives by informed refusal of recommended medical care, but they don’t have the right to risk their children’s lives. Parents who refuse to seek medical treatment for deadly conditions like diabetes are (appropriately) charged with medical neglect. It doesn’t matter whether the parental delusion is that diabetes can be cured by prayer, or alternative health, or simply watchful waiting. Parents are both ethically and legally obligated to make sure the child receives medical treatment.

How about prophylactic care?

We have no problem mandating car seats when babies travel in automobiles regardless of whether parents think that car seats are helpful or harmful. You can’t take your baby home from the hospital in a car unless you have an approved car seat.

Similarly, we should mandate prophylactic vitamin K shots regardless of what parents believe about them. The facts are clear. Hemorrhagic disease of the newborn is a real threat to babies’ health and vitamin K prevents it; the benefits of vitamin K outstrip any possible risks. You shouldn’t be allowed to take your baby home from the hospital unless that baby has received a prophylactic vitamin K shot.

Parents are free to hold whatever healthcare delusions they choose, but they ought not to be free to risk their babies’ lives in service of their delusions.