Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne

Area of Science:

• Neonatal medicine
• Bioethics
• Medical decision-making

Background:

• Extremely premature infants face high mortality and morbidity.
• Current therapies often have adverse outcomes.
• Family emotional and financial burdens necessitate re-evaluation of care approaches.

Purpose of the Study:

• To advocate for shared decision-making and informed consent in neonatal intensive care.
• To highlight inconsistencies between mandatory interventions and patient autonomy.
• To propose a framework for ethical periviability care.

Main Methods:

• Review of ethical principles of informed consent and shared decision-making.
• Analysis of current practices in neonatal intensive care for extremely premature infants.
• Application of the concept of 'sophrosyne' to physician conduct.

Main Results:

• Mandatory resuscitation or rigid palliative care policies conflict with informed consent principles.
• Shared decision-making requires family understanding, risk-benefit assessment, and value alignment.
• Physicians must balance interventions with patient autonomy and humility.

Conclusions:

• Informed choice is a fundamental right in preference-sensitive neonatal care.
• Evidence-based guidelines and decision aids are essential for structured informed consent.
• Ethical periviability care necessitates respecting family values and preferences.