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Ethical care for infants with conditions not curable with intensive care
Bethan J Everett1, Susan G Albersheim
1Faculty of Medicine, Department of Physical Therapy, University of British Columbia. bjeverett@shaw.ca
Insights
Disagreements arise regarding intensive care for neonates with poor prognoses. A proposed framework enhances communication between physicians and parents on best interests and treatment decisions for infants with lethal conditions.
Area of Science:
- Medical Ethics
- Neonatal Intensive Care
- Pediatric Prognosis
Background:
- Intensive care decisions for neonates with extremely poor prognoses are ethically contentious.
- Physicians and parents often have differing interpretations of "best interests" for these infants.
- Current practices lack a unified approach to determining appropriate care for neonates with lethal conditions.
Purpose of the Study:
- To define "best interests" for infants with lethal conditions unresponsive to intensive care.
- To establish a framework for deciding on treatment options for such neonates.
- To improve consensus between healthcare providers and families regarding neonatal care.
Main Methods:
- Analysis of ethical considerations in neonatal intensive care.
- Development of a decision-making framework for "best interests" in neonatal care.
- Exploration of communication strategies between physicians and parents.
Main Results:
- The concept of "best interests" requires careful consideration in neonatal intensive care, especially for infants with lethal conditions.
- A framework is proposed to align physician and parental perspectives on appropriate treatment.
- Informing parents about the basis of treatment evaluations can foster trust and understanding.
Conclusions:
- Implementing a transparent framework can enhance dialogue and trust in neonatal care decisions.
- Shared understanding of "best interests" is crucial for reaching consensus on intensive care for neonates with poor prognoses.
- This approach aims to improve the collaborative decision-making process for critically ill infants.
Abstract:
Offering intensive care to neonates who have conditions that carry extremely poor prognoses is a source of great contention amongst neonatologists. The concept of best interests is commonly used as a rationale for refusing such care, despite the fact that parents of these infants often have a different view of what best interests means. This article takes up the question of what best interests should incorporate for infants with lethal conditions not curable with intensive care, and how and who should decide which treatment options should be implemented. Based on our recommendation that parents be apprised of the basis upon which physicians are evaluating treatment options, we offer a framework that allows all relevant parties to approach the issue of what is appropriate treatment from a similar place. We maintain that this approach will increase transparency, dialogue, understanding, and trust, which, in turn, may result in greater consensus.
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