Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard

Area of Science:

• Neonatal Ethics
• Medical Bioethics
• Pediatric Medicine

Background:

• The Best Interests Standard (BIS) is crucial in neonatal decision-making regarding life-sustaining therapy (LST).
• Understanding differing conceptualizations of the BIS among neonatologists and bioethicists is essential for ethical practice.

Purpose of the Study:

• To investigate how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS).
• To compare the perspectives of neonatologists and bioethicists on the appropriateness of forgoing LST.

Main Methods:

• Survey distributed to members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine.
• Assessed conceptualizations of the BIS and ranked the appropriateness of forgoing LST in various neonatal scenarios.

Main Results:

• Neonatologists favored an infant-specific BIS, linking infant and family interests but rejecting limitations on family obligations.
• Bioethicists supported a broader BIS, including family impact and limitations on family obligations, viewing it as less infant-specific.
• Bioethicists were less likely than neonatologists to agree with forgoing LST in most cases.

Conclusions:

• Significant divergence exists between neonatologists and bioethicists regarding the BIS, particularly concerning family impact and obligations.
• Neonatologists' views were divided on BIS conceptualization, while bioethicists favored a family-inclusive approach.
• Further critical appraisal of the BIS is warranted within neonatal ethics to reconcile these differing perspectives.