Scandinavian perspectives on life support at the border of viability

Area of Science:

• Neonatal medicine
• Medical ethics
• Perinatal care

Background:

• Advances in neonatal medicine enable the rescue of extremely preterm infants.
• Decreasing gestational age correlates with increased long-term vulnerability and treatment burden.
• A "grey zone" exists regarding the justification of life support for periviable infants.

Purpose of the Study:

• To provide an overview of national consensus documents and practices in Norway, Sweden, and Denmark regarding periviable infants.
• To reflect on the ethical justification for differing approaches to periviable infant care in Scandinavia.
• To explore the decision-making process for life support at the border of viability.

Main Methods:

• Review of national consensus documents.
• Analysis of clinical practices in Norway, Sweden, and Denmark.
• Ethical reflection on differing Scandinavian approaches to periviable infants.

Main Results:

• Swedish guidelines and practices are more rescue-focused at the lower limit of viability.
• Danish guidelines prioritize parental involvement in decision-making for periviable infants.
• Norwegian practices appear to be intermediate between Sweden and Denmark.

Conclusions:

• Scandinavian countries exhibit distinct approaches to periviable infant care despite cultural similarities.
• Ethical justifications for these differing approaches warrant further investigation.
• The "grey zone" at the border of viability necessitates clear ethical frameworks and guidelines.