Legal issues in neonatal intensive care

The issues surrounding the selective nontreatment of disabled neonates are complex. These difficult problems are exacerbated by an ambiguous legal environment in which existing statutes are not enforced and case law provides guidance but little clear leadership (Weir 1984). It is difficult to measure the effect such legal mire has on those who make the nontreatment decisions and those who guide those who make them. While some published material suggests that physicians will act in what they believe to be the patient's best interests without regard for the law, others may be more intimidated (Frohock 1986), and even among those who are not, it is not clear whether their decisions are indeed wise and just. The status quo of laws selectively enforced is desirable to some, but having laws that are selectively enforced may make others fearful and suspicious. Nonenforcement of the laws also allows individual parents and physicians wide discretion in the making of these decisions that may not be in the best interest of the infants involved (Crossley 1987). There should be, within the legal system, a goal of providing a framework that provides consistency in the application of nontreatment decisions, removes the legal ambiguity that surrounds such decisions, and reflects a societal consensus about neonatal intensive care treatment issues (Robertson 1981; Weir 1984). Such a framework might be institution based, legislated, or a combination using state-provided child advocates and hospital ethics committees. In the absence of such a framework hospitals should be cautious to provide the necessary mechanisms for the concurrent review of neonatal nontreatment decisions so as to prevent liability for themselves and their staffs. Such reviews should be made by a committee of experts. The committee should be willing to comply with the reporting laws and to turn to the courts when necessary.