Related Experiment Videos
The uncertain 'best interests' of neonates: decision making in the neonatal intensive care unit
1Prizker School of Medicine, University of Chicago, Illinois, United States.
Insights
Decisions to forego treatment for critically ill infants in neonatal intensive care units (NICUs) involve complex ethical and legal considerations. Balancing medical uncertainty with the
Area of Science:
- Neonatal medicine and intensive care.
- Medical ethics and decision-making.
- Legal and philosophical theories in healthcare.
Background:
- Neonatal intensive care units (NICUs) utilize advanced technology to save critically ill infants.
- Despite advances, not all infants can be saved, necessitating difficult treatment decisions.
- Scrutinizing the basis for foregoing treatment is essential in neonatal care.
Purpose of the Study:
- To examine the development of scientific, legal, and philosophical theories guiding medical decisions in NICUs.
- To delineate the nexus linking these theories in neonatal intensive care.
- To analyze the 'best interests of the child' standard in the face of medical uncertainty.
Main Methods:
- Review of scientific, legal, and philosophical theories across Canada, the United States, and the United Kingdom.
- Analysis of how medical standards and moral philosophy inform legal rules.
- Examination of the increasing reliance on the 'sanctity of life' principle.
Main Results:
- Medical decision-making in NICUs is informed by professional standards and moral philosophy.
- Medical uncertainty regarding outcomes shifts the 'best interests' standard towards 'sanctity of life'.
- Judicial reliance on the 'sanctity of life' increases as 'medical futility' is redefined by science.
Conclusions:
- Both subjective and objective factors are crucial for optimal decision-making in NICU care.
- The 'sanctity of life' principle plays a significant role, particularly in cases of medical uncertainty.
- A balanced approach is needed to protect the best interests of the child.
Abstract:
Neonatology is a recently specialized area of medicine in which medical advances continue to save the lives of many ailing infants. However, like most areas of health care, it is not a perfect science, and hence not all infants can be saved, no matter how advanced the technology or how well-trained the physician. Inevitably, decisions regarding when to forego treatment must be made. It is essential to scrutinize the bases upon which these decisions are reached. This article examines the development of the scientific, legal and philosophical theories in Canada, the United States and the United Kingdom in an attempt to delineate a nexus wherein these theories link together to found medical decisions in the neonatal intensive care unit. Legal rules of medical decision making are informed by standards set by the medical profession as well as by principles of moral philosophy. However, in the face of medical uncertainty regarding outcomes, the content of the 'best interests' of the child standard increasingly relies upon a normative conception of the 'sanctity of life'. Ironically, as science pushes at the bounds of the meaning of 'medical futility', the sanctity of life position gains strength and is relied upon more frequently by the judiciary. The author concludes that both subjective and objective factors must inform this decision making in order to protect the best interests of the child optimally.