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Futility considerations in the neonatal intensive care unit

G B Avery1

  • 1Children's National Medical Center, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.

Seminars in Perinatology
|July 3, 1998
PubMed
Summary

Medical decision-making in neonatal intensive care has evolved over 35 years, grappling with the concept of treatment futility. Current legal and societal pressures create unresolved challenges for neonatologists and families.

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Area of Science:

  • Neonatal Intensive Care
  • Medical Ethics
  • Health Law

Background:

  • Medical decision-making in neonatal intensive care units (NICUs) has a complex history.
  • The concept of treatment futility has been a persistent ethical challenge for neonatologists over the past 35 years.
  • Shifting roles of healthcare providers, families, and societal proxies have influenced these decisions.

Purpose of the Study:

  • To summarize and comment on the historical evolution of medical decision-making in the NICU.
  • To emphasize the role of futility considerations in neonatal care.
  • To analyze the impact of legal and societal mandates on these decisions.

Main Methods:

  • Historical review of medical decision-making epochs in neonatal intensive care.
Keywords:
Baby DoeDeath and Euthanasia

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  • Analysis of the evolving roles of stakeholders including physicians, families, and legal/societal entities.
  • Examination of the influence of regulations, court decisions, and economic factors.

    • Main Results:

    • Futility has been a central consideration for neonatologists, particularly with severe malformations, birth asphyxia, and extreme prematurity.
    • Parental autonomy has gained increasing affirmation in decision-making processes.
    • Legal and economic pressures from the 1980s and 1990s have imposed boundaries, sometimes conflicting with ethical considerations.

    Conclusions:

    • The issue of medical futility in neonatal care in the United States remains unresolved.
    • Conflicting legal and societal mandates complicate decision-making processes.
    • Ongoing dialogue is needed to address the complexities of futility in neonatal intensive care.