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Updated: Jul 10, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Harm and uncertainty in newborn intensive care
1Department of Philosophy, University of Hawaii at Manoa, 2530 Dole Street, Honolulu, HI 96822, USA. kkipnis@hawaii.edu
Insights
Neonatologists face ethical dilemmas with premature infants. Uncertainties in predicting outcomes and defining "good" survival mean parents
Area of Science:
- Medical Ethics
- Neonatology
- Pediatric Bioethics
Background:
- A prevailing ethical view holds neonatologists should override parental nontreatment decisions for premature infants with good outcome potential.
- This perspective often overlooks the complexities and uncertainties inherent in neonatal intensive care.
Purpose of the Study:
- To challenge the general ethical obligation of neonatologists to override parental nontreatment decisions for premature newborns.
- To highlight specific uncertainties that undermine this obligation.
Main Methods:
- Ethical analysis of decision-making in neonatal care.
- Examination of the concept of "good outcome" in the context of extreme prematurity.
- Discussion of the ethical weight of potential harm versus benefit in neonatal interventions.
Main Results:
- Three key uncertainties challenge the obligation to override parental decisions: defining intolerable deficits, predicting treatment outcomes (good vs. impaired survival), and balancing likelihoods of these outcomes.
- Newborn intensive care can increase the risk of harm by resulting in survival with severe deficits.
- The broadly held view may not adequately weigh the potential for iatrogenic harm.
Conclusions:
- Neonatologists should recognize the limits of certainty in predicting outcomes for extremely premature infants.
- In certain situations, ethical considerations support deferring to parental nontreatment decisions, even when a "good outcome" is possible.
- A nuanced ethical approach is required, acknowledging parental values and the uncertainties of neonatal intensive care.
Abstract:
There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant's deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions.
