Drew, I think most of us want to feel that a doctor will use every heroic measure to save and prolong life--regardless of the hopelessness of the situation. But, in many instances, that approach may only cause greater pain and suffering, and, in the case of a 22 1/2 week fetus, it may only delay the inevitable by a few hours, at most.
Very few 22 1/2 week fetuses survive for any length of time outside utero--no matter what is done--and of those that can survive for a time, most suffer severe deficits which make continuation of life impossible. That is why abortions are permissible at that stage of development--these fetuses are not considered viable. While it might seem a simple matter for a doctor to do something, like providing oxygen immediately after birth, often it turns out that the amount of oxygen is too little or too much, and it causes even more damage without appreciably extending life. This isn't normal prematurity, it is extreme prematurity, and, in that sense, I would see this birth as akin to a miscarriage.
Medical malpractice involves actions which are beyond a reasonable error in medical judgment. Did this doctor make mistakes which his colleagues would agree went beyond reasonable errors in judgment? Did he willfully fail to deliver needed medical care that would have led to the long term survival of this fetus, and would other doctors agree he had been negligent? With a 22 1/2 week fetus, I doubt whether other doctors would view this physician's actions as either malpractice or negligence. In a civil court you really could not mount a strong case for a wrongful death suit.
You don't know exactly what the doctor said to your friend regarding the fetus's condition or viability. Did your friend urge the doctor to take any heroic measures after the birth? Did she accept the doctor's explanation for what he was doing, or not doing, at the time? Could your friend be having doubts or guilt, after the fact, about whether more should have been done--even if such attempts would have been futile?
If your friend has lingering questions about what happened, she should make an appointment to meet with the doctor so that he can explain the situation to her again and explain why no treatment was offered. If that is not possible, then she should write him a letter, pose her questions in the letter, and see if she receives a reply. If that does not work, she can complain, to a medical association or the state, that the doctor is behaving unprofessionally by not communicating or meeting with her.
Rather than randomly seeking opinions on the internet, your friend can meet with a medical malpractice attorney, or just speak with one on the phone. Most offer a free consultation. Since they work on a no-fee contingency basis, they do not take a case unless they think they can win it. So, they can tell your friend rather quickly whether they think malpractice or negligence occurred. They can also get the hospital records to see exactly what occurred if they feel the matter is worth pursuing.
I am terribly sorry for your friend's loss, and for your distress about the loss.
I would also be interested in your response to High Seas question
So what WAS your opinion on why the hospital did not do more in this case?