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Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Janicke Syltern1,2, Lars Ursin3, Berge Solberg3

  • 1Norwegian University of Science and Technology.

The American Journal of Bioethics : AJOB
|May 17, 2021
PubMed

Insights

This study introduces "postponed withholding" for periviable infants, starting life support then redirecting to palliative care after a week unless parents opt out. This approach aids ethical decision-making in complex neonatal care scenarios.

Area of Science:

  • Neonatology
  • Medical Ethics

Background:

  • Neonatal survival has improved, but periviable infants face high risks of harm.
  • Uncertainty in neonatal care creates ethical dilemmas regarding life support.
  • Shared decision-making with parents is crucial but challenging due to immediate life support needs and withdrawal resistance.

Purpose of the Study:

  • To propose a novel ethical framework for decision-making in neonatal intensive care for periviable infants.
  • To address the tension between immediate life support and fair, shared decision-making processes.
  • To support healthcare personnel and empower parents in ethically complex situations.

Main Methods:

  • Introduction of the "postponed withholding" approach.
  • Life support initiated at birth for periviable infants without prenatal directives.
  • Planned redirection to palliative care after one week, contingent on parental counseling and consent.

Main Results:

  • The "postponed withholding" approach facilitates ethically balanced decisions.
  • It addresses parental "instinct of saving" and "withdrawal resistance."
  • Enables a structured decision-making process in the "gray zone" of neonatal care.

Conclusions:

  • "Postponed withholding" offers a structured method for navigating ethical dilemmas in periviable infant care.
  • This approach balances the initiation of life support with the potential for palliative care redirection.
  • It aims to empower parents and healthcare providers in making difficult end-of-life care decisions.

Keywords:
Children and familiesdecision-makingend-of-life issuespediatrics: neonatologyprofessional-patient relationship

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