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Treatment decisions for newborns at the threshold of viability: an ethical dilemma
R W Doroshow1, J E Hodgman, J J Pomerance
1Department of Pediatrics, Harbor-University of California Los Angeles Medical Center, Torrance, USA.
Insights
Ethical decision-making for extremely low birth weight newborns should prioritize parental involvement and institutional mortality risk over arbitrary weight limits. Resuscitation decisions should be made prenatally when possible, or in the delivery room, with ongoing care contingent on survival likelihood and parental wishes.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Pediatric Care
Background:
- Ethical dilemmas frequently arise in the care of extremely low birth weight (ELBW) newborns.
- Existing decision-making frameworks may lack clarity or consistency.
- Parental involvement in critical care decisions is a key ethical consideration.
Purpose of the Study:
- To analyze major ethical issues in ELBW newborn care decision-making.
- To propose an ethical assessment and management schema for ELBW infants.
- To integrate institutional mortality risk and parental preferences into care decisions.
Main Methods:
- Analysis of ethical issues in neonatal intensive care.
- Development of a decision-making schema based on ethical principles.
- Incorporation of institutional mortality data and parental input.
Main Results:
- A proposed schema emphasizes institutional mortality risk over arbitrary weight limits.
- Parents are assigned a major decision-making role in infant care.
- Recommendations are provided for pre-delivery, delivery room, and ongoing care decisions.
Conclusions:
- The proposed schema aligns with pediatric ethical principles.
- Decisions regarding resuscitation and continued care should be dynamic and informed by survival probability and parental values.
- This approach supports ethically sound and individualized care for ELBW newborns.
Abstract:
The major ethical issues involved in decision-making in the care of extremely low birth weight newborns are analyzed here. We propose a schema for assessment and management of these infants that is consistent with ethical principles broadly accepted by the pediatric community, and which takes into account mortality risk at any given institution rather than arbitrary weight limits, with a major decision-making role for the infant's parents. When possible, the decision of whether or not to resuscitate should be made before delivery; when not possible, delivery room resuscitation is recommended, and the decision to continue or withdraw care should be made subsequently based on likelihood of survival and the wishes of the parents.
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