Ethical considerations in neonatal respiratory care

Area of Science:

• Neonatal Medicine
• Medical Ethics
• Bioethics

Background:

• Advances in neonatal care have improved survival rates for critically ill and preterm infants.
• The concept of viability has shifted, leading to complex ethical dilemmas.
• Intensive care can prolong life but may also cause suffering or severe disabilities.

Purpose of the Study:

• To review the ethical principles guiding decisions on neonatal intensive care withdrawal.
• To identify circumstances necessitating consideration of withholding or withdrawing life support.
• To explore the role of parents and neonatologists in these critical decisions.

Main Methods:

• Literature review of ethical principles in neonatal end-of-life care.
• Analysis of common scenarios in neonatal intensive care units (NICUs).
• Examination of parental involvement and neonatologist practices in decision-making.

Main Results:

• Ethical frameworks support withholding/withdrawing care when it prolongs suffering without benefit.
• Decisions are complex, involving infant prognosis, quality of life, and parental values.
• Neonatologist practices vary across American and European NICUs.

Conclusions:

• Withholding or withdrawing mechanical ventilation and other intensive treatments may be ethically appropriate.
• Shared decision-making involving parents, medical teams, and ethics committees is crucial.
• Understanding and addressing variations in neonatologist behavior is important for consistent ethical care.