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An Ethical Pathway to Quality of Life in Critically Ill Newborns
Agustín Silberberg1, María Soledad Paladino2, José Manuel Moreno-Villares3
1Department of Bioethics, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina.
Insights
Quality of life (QoL) is crucial in neonatal care decisions regarding life-sustaining treatment (LST). However, QoL alone is insufficient for these complex ethical choices.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Perinatology
Background:
- Advances in perinatology enable survival of fragile neonates.
- Quality of Life (QoL) is increasingly considered in medical decision-making.
- The use of QoL in decisions about withholding or withdrawing life-sustaining treatment (LST) is debated.
Purpose of the Study:
- To analyze the role of QoL in decisions regarding LST for neonates.
- To explore the challenges and risks associated with using QoL as a sole criterion for LST decisions.
Main Methods:
- Literature review analyzing the concept and application of QoL in neonatal LST decisions.
- Discussion of ethical principles relevant to clinical decision-making.
Main Results:
- QoL is a significant factor but faces conceptual difficulties, including lack of consensus on definition and objective measurement.
- Basing LST decisions solely on QoL presents risks of subjective assessment.
- The principles of totality and therapeutic adequacy should guide decisions.
Conclusions:
- Therapeutic persistence may be reasonable with uncertain prognosis.
- Continued LST may not be appropriate for neonates with severe disabilities if there is no clinical benefit.
- QoL is essential but insufficient as the sole criterion for neonatal LST decisions.
Abstract:
Advances in perinatology have permitted the survival of fragile neonates. Quality of life (QoL) has been considered a key element in medical decision-making. In this review we analyse the role of QoL regarding the decision of withholding or withdrawing of life-sustaining treatment (LST). The role of QoL is debated because of the conceptual difficulties it raises. The lack of consensus on its definition and the difficulties in measuring it objectively, mean that basing clinical decisions solely on QoL has some risks. To avoid a purely subjective assessment, the principle of totality, and the principle of therapeutic adequacy should be considered. In case of uncertain prognosis, some therapeutic persistence seems reasonable. If this does not benefit the clinical condition of the child, then it may be no longer appropriate to continue the LST in case of severe disabilities. QoL is essential in medical decision-making, but is insufficient as the only criterion.
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