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The limits of viability
F A Chervenak1, L B McCullough
1Department of Obstetrics and Gynecology, New York Hospital, Cornell Medical Center, NY, USA.
Journal of Perinatal Medicine
|January 1, 1997
Insights
This study ethically analyzes mortality and morbidity in very premature infants. It concludes that infant viability should be considered at 24 weeks gestation, not 23 weeks.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Perinatal Research
Background:
- Very premature infants face significant risks of mortality and long-term morbidity.
- Current guidelines on fetal viability are debated, impacting clinical and ethical decisions.
- The divergence between survival rates and potential health complications necessitates ethical re-evaluation.
Purpose of the Study:
- To conduct an ethical analysis of the divergence between mortality and potential morbidity in very premature infants.
- To establish a gestational age threshold for viability based on ethical considerations.
- To inform clinical practice and policy regarding the management of extremely preterm neonates.
Main Methods:
- Ethical analysis framework applied to neonatal outcomes.
- Review of current literature on preterm infant mortality and morbidity data.
- Consideration of potential long-term health consequences and quality of life.
Main Results:
- Significant ethical concerns arise from the divergence of mortality and morbidity risks at 23 weeks gestation.
- Infants born at 23 weeks have a substantial risk of severe morbidity, challenging the definition of viability.
- A gestational age of 24 weeks or greater is ethically supported as the threshold for viability.
Conclusions:
- Current ethical standards support defining viability at 24 weeks gestation or later.
- The potential for severe morbidity at 23 weeks outweighs the benefits of intervention based on ethical principles.
- This ethical framework aims to guide decisions promoting the best interests of extremely preterm infants.
Abstract:
We provide an ethical analysis of the divergence of mortality and potential morbidity in very premature infants. Based on this ethical analysis we conclude that at this time viability should be at 24 weeks or greater and not at 23 weeks.
Keywords:
Professional Patient Relationship
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