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Ethical considerations in neonatal respiratory care

Marcello Orzalesi1, Marina Cuttini

  • 1Bambino Gesù Children's Hospital, Rome, Italy. orzalesi@opbg.net

Biology of the Neonate
|June 30, 2005
PubMed

Insights

Decisions about neonatal intensive care involve ethical considerations when survival means suffering. Withholding or withdrawing life support may be a compassionate choice in specific critical infant cases.

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.

Keywords:
Death and Euthanasia

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