Doctor-Parent Disagreement for Preterm Infants Born in the Grey Zone: Do Ethical Frameworks Help?

Area of Science:

• Medical Ethics
• Neonatal Care
• Bioethics

Background:

• Parent-doctor disagreements are common in neonatal intensive care units.
• The
• grey zone
• presents unique ethical challenges for extremely preterm infants.
• Existing ethical frameworks may require adaptation for these complex cases.

Purpose of the Study:

• To evaluate the utility of ethical frameworks in resolving parent-doctor disagreements for extremely preterm infants.
• To identify challenges faced by stakeholders when applying ethical frameworks in grey zone cases.

Main Methods:

• Case analysis of a specific parent-doctor disagreement.
• Application of two ethical frameworks: the best interest standard and the zone of parental discretion.

Main Results:

• Ethical frameworks offer structured decision-making, clarify ethical issues, and facilitate agreement.
• Key challenges include objectively assessing severe disability risk, determining the extent of parental interests, and navigating subjective value differences.

Conclusions:

• Ethical frameworks are valuable tools for navigating complex grey zone cases.
• Identified challenges highlight the inherent complexity and sensitivity of decision-making for extremely preterm infants, not framework deficiencies.