Approaches to ethical decision making in the neonatal intensive care unit

Despite the "Baby Doe" regulations, there is no consensus on principles for deciding the fate of severely handicapped neonates. This essay analyzes four alternate positions--value of life, parental authority, best interests, and personhood--and suggests for consideration a fifth, ie, proximate personhood. The latter position, building on the strengths of the first four, argues that a handicapped newborn must possess a reasonable potential for minimal personal capacities to have a unique claim to life. Projected minimal capacities include personal self-awareness and net physiological benefit. If newborns are not expected to develop such capacities, parents should be free to choose the option of nontreatment.