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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Parental authority, patient's best interest and refusal of resuscitation at borderline gestational age
1Department of Pediatrics, Yale University School of Medicine, Yale University Interdisciplinary Bioethics Center, New Haven, CT, USA. mark.mercurio@yale.edu
Insights
Physicians may override parental refusal for newborn resuscitation at a certain gestational age, balancing the child
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Bioethics
Background:
- Parental refusal of medical interventions for children presents ethical dilemmas.
- This conflict is particularly relevant in neonatal care, specifically regarding the resuscitation of preterm infants.
Purpose of the Study:
- To determine the ethical threshold for neonatal resuscitation against parental wishes.
- To establish guidelines for ethically justified medical interventions in cases of parental refusal.
Main Methods:
- Ethical reasoning applied to determine the gestational age threshold for resuscitation.
- Assessment of benefits and burdens of resuscitation, considering short-term and long-term outcomes.
- Analysis of relevant mortality and morbidity data for preterm infants.
Main Results:
- Most neonatologists respect parental refusal at borderline viability.
- A gestational age threshold exists above which physicians are ethically justified in resuscitating despite parental refusal.
- Decision-making requires balancing the patient's best interest with family considerations.
Conclusions:
- Ethical decision-making for neonatal resuscitation should be based on reasoned analysis, not arbitrary standards.
- The threshold for intervention must consider the child's prognosis and the potential impact on the family.
- A nuanced approach is necessary, integrating medical data with ethical principles.
Abstract:
Potential conflict exists when parents refuse a medical intervention for their child that the physician feels obligated to provide. For the anticipated delivery of a preterm newborn, this conflict might exist if the parents refuse resuscitation. At borderline viability, most neonatologists are likely to respect the parents' wishes. However, there will be some gestational age threshold above which the physician will feel compelled to resuscitate despite parental refusal, and will be ethically justified in doing so. The location of that threshold should be determined by the application of sound ethical reasoning, rather than relying on habit or arbitrary standards. That reasoning should include an honest assessment of the benefits and burdens to the child, short-term and long-term, of attempted resuscitation, made in light of relevant mortality and morbidity data. However, a rational analysis will also require consideration of whether the patient's best interest standard should be strictly applied, or whether the interests of others, such as family members, should also be taken into account.
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