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Published on: November 20, 2015
[Ethical problems regarding extremely preterm infants]
1Klinik für Neonatologie, Departement für Frauenheilkunde, Universitätsspital Zürich, Zürich, Schweiz. buh@usz.ch
Insights
Advances in neonatal intensive care for premature infants have led to increased survival but also chronic health issues. A majority of European neonatologists favor stopping intensive care when it causes suffering without benefit.
Area of Science:
- Neonatal Medicine
- Medical Ethics
Background:
- Industrialized nations have seen increased survival of extremely preterm infants over 20 years.
- This has led to longer intensive care, infant suffering, and worse long-term outcomes, including chronic lung, eye, and brain conditions (cerebral palsy).
Purpose of the Study:
- To explore the ethical considerations and practices surrounding the limits of intensive care for extremely preterm infants.
- To understand the spectrum of opinions among neonatologists and nursing staff regarding the withdrawal of intensive care.
Main Methods:
- A survey of neonatologists and nursing staff across Europe was conducted.
- The study investigated opinions on gestational age limits and criteria for discontinuing intensive care.
Main Results:
- A wide spectrum of opinions exists regarding the limits of intensive care for preterm infants.
- A majority supports discontinuing intensive care when it leads to prolonged suffering without improving the infant's best interest.
Conclusions:
- Difficult medico-ethical decisions regarding intensive care for preterm infants require structured approaches.
- Specialized procedures have been developed and validated to aid in these complex decisions, prioritizing infant well-being over prolonged suffering.
Abstract:
In the industrialized countries during the last 20 years, ever smaller preterm infants have been re-animated after birth, subjected to mechanical ventilation, fed parenterally and treated with various drugs. The smaller and more premature the infant, the longer the intensive care, the greater pain and suffering for the infants concerned and the worse the long-term results. Although mortality decreased, chronic problems of the lungs, eyes and brain (cerebral palsy) increased in the surviving infants. Therefore specialists as well as the general public began to discuss the limits of using intensive medicine. Investigations among neonatologists and nursing staff all over Europe resulted in a wide spectrum of opinions where the line should be drawn, e.g. concerning gestational age. A majority is however in favour of stopping intensive care measures when these are not in the best interest of the infant, i.e. when treatment becomes painful and inescapable death is only postponed. In order to reach such a difficult medico-ethical decision in a structured, understandable and well-supported way, special procedures were developed, which have stood their test in practice.
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