Withholding and withdrawing life sustaining treatment in neonatal intensive care: issues for the 1990s (original) (raw)
Related papers
Decisions concerning resuscitation and end-of-life care in neonates. Bioethical aspects (Part II)
Archivos Argentinos De Pediatria, 2022
Coping with the death of a newborn infant requires training and reflection regarding the end-of-life decision-making process, communication with the family, and the care to be provided. The objective of this article is to analyze in depth the salient aspects of neonatal bioethics applied to end-of-life situations in newborn infants. Part I describes notions of therapeutic futility, redirection of care criteria, patient and family rights, and concepts about the value of life. Part II analyzes situations that deserve considering the redirection of care and delves into aspects of communication and the complex process of end-of-life decision-making in newborn infants.
Decisions concerning resuscitation and end-of-life care in neonates. Bioethical aspects (Part I)
Archivos Argentinos De Pediatria, 2022
Coping with the death of a newborn infant requires training and reflection regarding the end-of-life decision-making process, communication with the family, and the care to be provided. The objective of this article is to analyze in depth the salient aspects of neonatal bioethics applied to end-of-life situations in newborn infants. Part I describes notions of therapeutic futility, redirection of care criteria, patient and family rights, and concepts about the value of life. Part II analyzes situations that deserve considering the redirection of care and delves into aspects of communication and the complex process of end-of-life decision-making in newborn infants.
Neonatal end-of-life decisions and bioethical perspectives
a r t i c l e i n f o In the nineties the EURONIC project documented the staff views and practices regarding ethical decision-making in neonatal intensive care units of eight Western Europe countries: France, Germany, Great Britain, Italy, Luxembourg, Netherlands, Spain and Sweden. This paper reviews the changes occurred in the ethical and legal background of these countries, and discusses possible influences on neonatal care practices. To a certain extent, many of these changes appear to be in line with the neonatal physicians' views and attitudes previously documented by the EURONIC project, while some are not. Large differences persist within Western Europe on what constitutes appropriate neonatal end-of-life care.
End-of-life after birth: death and dying in a neonatal intensive care unit
Pediatrics, 2004
In canonical modern bioethics, withholding and withdrawing medical interventions for dying patients are considered morally equivalent. However, electing not to administer cardiopulmonary resuscitation (CPR) struck us as easily distinguishable from withdrawing mechanical ventilation. Moreover, withdrawing mechanical ventilation from a moribund infant "feels" different from withdrawing mechanical ventilation from a hemodynamically stable child with a severe neurologic insult. Most previous descriptions of withdrawing and withholding intervention in the neonatal intensive care unit (NICU) have blurred many of these distinctions. We hypothesized that clarifying them would more accurately portray the process of end-of-life decision-making in the NICU.
Swiss medical weekly, 2006
How do actual aspects of forgoing life supporting therapy (LST) in newborn infants compare with national ethical directives in a Swiss intensive care unit? A prospective set of data on deaths after forgoing LST over a three year period in a single intensive care unit is analysed in view of the directives issued by the Swiss Academy for Medical Sciences (SAMS). Thirty-four newborn infants died after a decision to forgo LST, 21 after withdrawing and 13 after withholding. The decision making process was confined to the caregivers' team. Parents rarely initiated the discussion but participated in all decisions and were considered as willing in 32% and consenting in 68%. Futility was invoked in 79% of cases and poor developmental outcome in 21%. Respiratory support was forgone in 59%, circulatory support in 6% and both in 35%. The mother assisted the child at the time of death in 91%. At that time, 82% of infants were receiving opiates and 18% benzodiazepines, some in a higher than u...
Ethical Dilemmas in the Neonatal Intensive Care Unit
Mayo Clinic Proceedings, 1987
After deliberation of the Baby Doe regulations issued in 1984, 1 the Supreme Court decided, on June 9, 1986, that withholding treatment from handicapped infants when parents are in agreement with this action does not violate laws for handicapped persons. 2 The historical and legal issues leading to the proposal of the Baby Doe regulations have been reviewed extensively elsewhere. 3 " 8 In short, these regulations, which are now incorporated into child abuse laws, establish general guidelines against withholding medical care from handicapped infants. 9 The public debate concerning the Baby Doe regulations has given high visibility to an aspect of neonatal medicine that has previously been largely unrecognized by the general public and nonpediatric medical community. Although much of the debate over the Baby Doe regulations has focused on the rights of handicapped persons to health care, the purposes of this editorial are (1) to identify additional issues that complicate ethical decision making for the preterm infant and (2) to review available means of support for coping with decision making for the preterm infant. Medical and Ethical Issues.-Neonatologists and parents must consider several major ethical issues when they make decisions concerning medical care for the preterm infant. Frequently, these issues are complex and necessitate the dovetailing of numerous ethical decisions with strictly medical decisions to achieve the final resolution. The following discussion is not inclusive but merely highlights some of the issues that complicate decision making in neonatal medicine. Dependent Patient.-One issue that creates ethical complexity in the neonatal intensive care unit (NICU) is the inability of the patient to exercise autonomy-that is, the preterm infant is incapable of making decisions for himself. Because babies cannot participate directly in decision making, influence may be exerted by multiple Address reprint requests to Dr.