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Infants born at 22 weeks have skin so gelatinous it bruises when they are touched."

  Infants born at 22 weeks have skin so gelatinous it bruises when they are touched.

A quarter-century after Roe vs. Wade, we've refined the discussion of abortion, but we're still missing the most important issues.

he older I get, the less I know. Twenty-five years ago, when the Supreme Court sidestepped the issue of when a fetus becomes a person in the Roe vs. Wade decision, it was clear to me that the fetus became a person when it could live independently from the mother. Now, I appreciate that the issue is much more complex.

Each day, I watch premature infants struggle to survive, to become independent human beings. I am both a neonatologist who uses our newest technology to save the lives of tinier, sicker babies, and a developmentalist who examines these tiny babies as they grow, develop, go home and begin their lives. Some are perfectly normal, dealing with only the usual struggles of childhood, adolescence, and emerging adulthood. Some have mild disabilities, but nonetheless will function well as adults. Others have profound mental or physical disabilities. They will be dependent on others for care all their lives. Each newborn is different. Neither survival nor outcome can be predicted with certainty.

Twenty-five years ago, many children who now survive would have died. I have learned that there is a tremendous variability in maturity. In 12-year-olds, maturity affects social relationships. At the limit of viability, maturity determines survival. When infants are born at 22 to 24 weeks' gestation, just over halfway through a pregnancy, they have skin so gelatinous it bruises when they are touched. They breathe, but only with a respirator pushing air through a plastic tube. We decide how hard the air is pushed, how often, how much oxygen it should contain. These infants exist on the very edge of viability. And despite our interventions, many die. But my patients are recognizable as babies.

I have learned to respect human life in all forms and at all ages. But I have also learned that being alive is not the ultimate value. Sometimes, we need to recognize that technology is merely prolonging suffering and death. Then, my job changes from saving lives to helping parents let go and helping a baby die with dignity and human compassion. I also have come to believe that all children should be wanted. Life is tough enough, and there's not enough societal support or protection for children who are unwanted.

When does a child become a person? Neurologic and cognitive abilities develop continuously, from embryo to adulthood. We do not suddenly become a person any more than we suddenly become an adult. As the pregnancy approaches full term, independent life outside the mother is increasingly possible, and the court wisely differentiated between early and late abortions.

Our focus on abortion is divisive, and does not allow us to address more important issues: how can we prevent unwanted pregnancies in the first place? How can we make our society more supportive to developing children? And, what can we do to minimize suffering for all children? We have a long way to go before we can say that our society fully respects and supports the personhood of children.

Marilee Allen is interim director of neonatology and associate professor of pediatrics at Johns Hopkins. This piece first aired on National Public Radio.