The extremely low birthweight infant: ethical issues in treatment

Survival and disability rates of extremely low birthweight infants have significantly improved. Since it is impossible to give an accurate prognosis at the time of birth, all such live births should be resuscitated and curative treatment, including the use of life support measures when appropriate, promptly initiated. In the event that medical facts indicate curative efforts are futile or lack compensating benefit, they should be discontinued and palliative treatment, which provides symptomatic relief and comfort, should be introduced. The attending neonatologist has the primary role as advocate for the infant and medical advisor to the parents, while the parents act as surrogates for their infant. The shift in emphasis from curative to palliative treatment requires medical consensus among all those involved in the care of the infant and consent from the parents closely involved in this widely shared decision. The role of infant bioethics committees is one of advisor and consultant to this decision-making process. Legislation needs to uphold the primary prejudice in favour of life while conceding that discontinuation of curative treatment, which is no longer effective, and the provision of palliative treatment, are appropriate medical decisions in exceptional cases.