Ethics ain't easy: do we need simple rules for complicated ethical decisions?
Janvier, A., Barrington, K. J., Aziz, K., & Lantos, J. (2008). Ethics ain't easy: do we need simple rules for complicated ethical decisions? Acta Paediatrica, 97 (4): 402-6.
Abstract: BACKGROUND: Recommendations from national bodies regarding extremely
preterm infants have focussed almost exclusively on thresholds for
intervention based upon estimated gestational age (GA) alone. METHODS:
We reviewed policy statements that address active intervention for
newborn infants and compare them with those that are available for
older patients. We reviewed research, examining attitudes towards
preterm infants, uncertainties in GA assessment and other factors
important in determining prognosis at the time of birth. RESULTS:
Policy statements regarding active care of very preterm infants treat
this population differently from others in morally significant
ways--without rationalizing this discrepancy. Extremely preterm infants
are devalued in medical and lay opinion compared to older individuals
with similar outcomes. Uncertainty in GA estimates often covers a range
with vastly differing prognoses. Sex, birth weight, inborn-outborn
status and use of antenatal steroids are vitally important in
prognosis, but clinical findings in the delivery room are not. Most
policy statements fail to account for these factors. CONCLUSION:
Simplistic policies based on GA alone should be avoided. Decision
making for extremely preterm infants should recognize that they are
each unique and must be individualized, taking into account all
relevant prognostic factors and the values and wishes of the families.
(My publication)Posted: Thursday, January 22, 2009