International variations in application of the best-interest standard across the age spectrum

Abstract

The value placed on the life of newborns is less than that expected according to predicted clinical outcomes and current legal and ethical theory relative to best interests. Value assessments on the basis of age, disability and prognosis appear to transcend culture, politics and religion in this domain.

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

“…The bias against premature infants has been wellstudied (Dupont-Thibodeau et al 2014, 2017Janvier et al 2008aJanvier et al , 2008bLaventhal et al 2017). Neonatologists sometimes share the bias and will forgo intensive care in extremely premature infants (Dupont-Thibodeau et al 2017;Janvier et al 2008aJanvier et al , 2008bLaventhal et al 2017). When considering treatment of premature infants, doctors, and parents both often focus on the possibility of survival with disabilities, rather than on the chances of survival alone (Janvier and Mercurio 2013).…”

Paediatric ethical issues during the COVID‐19 pandemic are not just about ventilator triage

“…5 Therefore, suggestions to stop ventilation for extremely premature infants are philosophically suspect, practically naïve and may inadvertently perpetuate a subconscious bias devaluing the worth of an extremely premature infant when compared with an older child or adult. [6][7][8] Broadening our view to other triage decisions for scarce resources would be helpful. The time we spend reflecting on ventilator triage decisions-which will most certainly not be needed-results in lost time for addressing other urgent issues.…”

Why Do Neonatologists in Scandinavian Countries and the Netherlands Make Life-and-death Decisions So Different?

“…18 The authors of 2 recently published international vignette studies confirmed the conservative and restricted approach in regard to providing care of extremely premature infants in the Netherlands today. 19,20 In the first study, Wilkinson et al 20 compared resuscitation thresholds for extremely premature infants between neonatologists in the United Kingdom, Sweden, and the Netherlands. They reported that neonatologists from the Netherlands had the least proactive approach to the resuscitation of these infants.…”