The History of Ethical Decision Making in Neonatal Intensive Care

Abstract

Neonatal ethics has focused on 2 questions: is withholding potentially live-saving treatment from neonates ethically justified? and if so, who has the authority to decide? This article details how these questions developed and provides a description of the possible answers. In the first section, we review a selection of seminal articles by noted authors in the fields of ethics, medicine, and law. The second section provides a detailed account of the development of the Baby Doe Regulations and the impact they had on neonatal ethics, with particular attention to the emergence of the Best Interest Standard as a guideline for decision making. In the last section, we review the landmark position statements by the American Academy of Pediatric (AAP), and the focus on evidence-based decision making. We conclude that forgoing life-saving treatment is ethically justified. However, this requires a rigorous evidence-based process and is limited by the Best Interest Standard. The second question is more difficult to answer, but we feel that in light of legal limitations, physicians acting as both the infant advocate and a proxy for the state, decide what falls in the range of acceptable treatment options, with the parents free to choose within that range.

Baby Doe Vakasi Özeli̇nde Engelli̇ Yeni̇doğanlara Dai̇r Eti̇k Sorunlarin Tari̇hi̇

“…Mahkeme kararı, yaşam hakkının en temel insani hak olduğu ve yaşam kalitesine bakılmaksızın, yaşam kurtarıcı müdahalenin yapılması gerektiği yönündeydi. Nihayetinde cerrahi müdahale gerçekleştirilmiş ve bebek bundan kısa bir süre sonra hayatını kaybetmişti (Paris, vd 2007: 428 başka makalede çatışan iki felsefeyi, vitalizm ve aktif ötanaziyi tartıştılar ve hasta odaklı bir yaklaşımı savundular (Placencia 2011: 371, Paris, vd 2007.…”

Family Centered Bioethics: A New Bioethical Framework for Decision-Making in Neonatal and Pediatric Units

“…However, if we analyze pediatric bioethics starting from the principle of autonomy, the only possible standard becomes the child's best interest [2], since its origin has been associated with the evaluation of treatments through the concept of expected quality of life (QL) [3] and has been widely criticized [4] and reformed [5]. This standard leads towards two extreme situations:…”

Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978‐2017

“…Interagency Group for Child Mortality Estimation 2018). Public attention to the plight of imperiled newborns in the United States increased in 1963 after the death of President John F. Kennedy's infant son, born at about 37 weeks, 39 hours after his birth (Lussky et al 2005, Placencia andMcCullough 2011). Yet the increase in resources devoted to neonatal care over the following decade, including the expansion of NICUs, was accompanied by concern for insufficient expertise to properly care for such unique, complex patients.…”