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Ethical dilemmas in decision making at limits of neonatal viability
1Assistant Professor of Clinical Pediatrics, Weill Medical College of Cornell University New York, Associate Director of Neonatal Intensive Care Unit, Associate Program director Pediatrics, New York Methodist Hospital, New York, New York.
Insights
Caring for extremely preterm infants involves complex decisions due to unpredictable outcomes. An individualized approach with open communication between parents and physicians is crucial for optimal care and respecting family wishes.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Medical Ethics
Background:
- Survival rates for extremely preterm infants have improved.
- Preterm birth, despite a 2% incidence, has profound impacts on infants, families, and healthcare systems.
- Births at the threshold of viability present complex medical, social, and ethical challenges.
Purpose of the Study:
- To address the challenges in decision-making for extremely preterm infants.
- To advocate for an individualized prognostic strategy in neonatal intensive care.
- To promote shared decision-making between parents and healthcare providers.
Main Methods:
- Review of current practices in neonatal intensive care.
- Analysis of ethical considerations in preterm infant delivery.
- Emphasis on communication strategies for shared decision-making.
Main Results:
- Survivors of extreme preterm birth face increased risks of chronic medical problems and disability.
- Decision-making at the threshold of viability is challenging due to unpredictable outcomes.
- An individualized prognostic strategy is recommended.
Conclusions:
- Effective communication and shared decision-making are vital for optimal care of extremely preterm infants.
- Consensual decisions respecting parental wishes and physician beneficence are paramount.
- Individualized prognostication supports ethical and patient-centered care.
Abstract:
The survival rate for extremely preterm infants has improved over the last two decades. Although the incidence of such births is about 2%, the impact of preterm birth on these infants, their families, health-care providers, and society is profound. The birth of an extremely low birth weight (ELBW) and early gestational age infant poses complex medical, social, and ethical challenges to the family and health-care professionals. Survivors have an increased risk of chronic medical problems and disability. It is difficult to make decisions while trying to provide optimal medical care to the infant and supporting the family when delivery occurs at the threshold of viability because outcome at that time is highly unpredictable. Such decisions may have lifelong consequences for those involved. An individualized prognostic strategy appears to be the most appropriate approach. While keeping the patient's best interest as the primary objective, the goal is to reach, through a process of effective communication between the parents and physicians, a consensual decision that respects the parents' wishes and promotes physician beneficence.
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