Infant treatment decisions: ethics and cost

Though society has been conditioned to believe that cost should not enter into medical care decisions, moral reasons do exist for considering cost in treatment decisions. Ethicists traditionally have distinguished between ordinary, or morally obligatory, means of preserving life and extraordinary, or morally optional, means. Treatment that offers a reasonable hope of benefit to the patient without excessive pain, expense, or other inconvenience would be considered ethically ordinary. Treatment that can not be obtained without excessive expense, which could greatly burden the patient's family and deprive them of other goods, could be legitimately withheld. The principle of proportionality, which requires balancing the probability and extent of potential harm against the probability and extent of good, also has been applied to medical care decisions. It has been used to focus attention on the cost of technologies and policies. Some have argued, however, that the individual patient--not a larger social good--should be the physician's only concern. Society should recognize that doing everything possible to save everyone who might survive leaves fewer resources to meet the needs of the poor and the disadvantaged. One way to limit the costs of intensive care, therefore, would be to limit the availability of neonatal treatment facilities. Infants would thus have to be selected for treatment according to prospects for survival or other medical indicators. Before society cuts back on infant care, however, it must address the question of justice. Since many low-birth weight babies are born to poor families, withholding infant treatment in some cases might increase, rather than reduce, the inequalities that already exist in health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)