Deciding for neonates: whose authority, whose interests?

Two principles are commonly perceived as being central to decision-making for critically ill newborns: the patient's best interest standard, and the authority of the parents to speak for the newborn as the surrogate decision-makers. In this essay, these 2 principles are examined in the context of a particular setting, that of a critically ill newborn with a mother in early adolescence. Alternatives to the patient's best interest standard are explored, including consideration of other interests in addition to those of the patient, such as the interests of the young mother and other family members. Also, we discuss a model of shared decision-making, wherein "parental authority" may be shared between the young adolescent mother and an adult relative, such as her own mother.