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Decision-making at the border of viability: determining the best interests of extremely preterm infants
1School of Nursing and Department of Philosophy, Duquesne University, Pittsburgh, Pennsylvania, USA vogelsteine@duq.edu.
Insights
This study presents a framework to determine if life-saving treatment benefits extremely preterm infants. The findings suggest that even the youngest infants, born at 22 weeks gestational age, should typically receive this treatment.
Area of Science:
- Neonatal Medicine
- Bioethics
- Perinatal Research
Background:
- Extremely preterm infants face significant survival and quality-of-life uncertainties.
- Decisions regarding life-saving treatment at birth require careful consideration of potential outcomes.
- Ethical frameworks are crucial for guiding clinical choices in neonatal intensive care.
Purpose of the Study:
- To propose and utilize a framework for evaluating the best interests of extremely preterm infants regarding life-saving treatment.
- To analyze the ethical considerations of providing intensive care to infants born at the threshold of viability.
- To inform clinical decision-making for neonates born at 22 weeks gestational age.
Main Methods:
- Development of a decision-making framework incorporating outcome probabilities and well-being assessments.
- Application of the framework using existing data and plausible assumptions about infant outcomes.
- Ethical analysis of the trade-offs between potential benefits and harms of life-saving interventions.
Main Results:
- The proposed framework indicates that life-saving treatment is generally in the best interests of extremely preterm infants.
- Even infants born at 22 weeks gestational age are likely to benefit from life-saving interventions.
- The analysis highlights the importance of considering long-term well-being in neonatal treatment decisions.
Conclusions:
- A structured ethical framework supports the provision of life-saving treatment for extremely preterm infants.
- The decision to treat should prioritize the potential for a life with acceptable well-being, even with uncertain outcomes.
- This approach provides a rational basis for ethically sound neonatal care at the limits of viability.
Abstract:
This paper proposes and employs a framework for determining whether life-saving treatment at birth is in the best interests of extremely preterm infants, given uncertainty about the outcome of such a choice. It argues that given relevant data and plausible assumptions about the well-being of babies with various outcomes, it is typically in the best interests of even the youngest preterm infants-those born at 22 weeks gestational age-to receive life-saving treatment at birth.
