The ethics of delivery-room resuscitation (original) (raw)
Related papers
What We Do When We Resuscitate Extremely Preterm Infants
The American journal of bioethics : AJOB, 2017
Children's Mercy Kansas City Neonatal intensive care is one of the most successful medical innovations of the last half century. Every year, in the United States alone, nearly 500,000 babies are born prematurely. Before neonatal intensive care, most of those babies died, and those who survived often suffered significant life-limiting impairments. Today, most preemies survive without impairments. In spite of this success, neonatal intensive care unit (NICU) care has always been viewed as ethically problematic. The objections to this care have taken different forms at different times. Economists questioned whether neonatal intensive care was cost-effective (Meadow et al. 2012; Rogowski 1998). Careful studies showed that it was more cost-effective than any other form of intensive care (Lantos and Meadow 2011), and even more cost-effective than many modalities of preventive care (including, for example, Pap smears) (Cutler and McClellan 2001). Some parents claimed that doctors were not honestly informing them of the potential long-term sequelae of NICU care, and that, if honestly informed, many parents would choose palliative care (Harrison 2001). Careful studies showed that these parents were unusual. Most parents want more intensive care than even doctors and nurses think is appropriate, and they want it even when informed that survivors might be left with significant disabilities (Lam et al. 2009; Streiner et al. 2001,). Bioethicists and doctors argued that neonatologists were playing God (Drane 1989), that premature babies were not full-fledged persons (Christoffersen-Deb 2012), and that saving disabled babies was like an ill-conceived military mission (Duff 1981). Each of these attempts to undermine the commitment made by parents, doctors, and society to saving preemies has been met with hard questions and strong rebuttals. But people just keep trying to find reasons why we shouldn't offer treatment that might save the lives of tiny babies.
BMC Medical Ethics
Background Deciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists’ clinical–ethical decision-making for resuscitation of EPIs. Methods We conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven. Results The main principles guiding participants’ decision-making were EPIs’ best interest and respect for parents’ autonomy. Participants agreed that justice as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs’ best interest and respect for parents’ autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24–25 weeks). Pa...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2011
Across Canada, the rate of preterm birth (i.e., at < 37 weeks' gestation) has been steadily increasing. Advances in perinatal medicine and neonatal intensive care have resulted in an increased capacity to intervene at the extremes of prematurity, leading to an increase in the overall survival of infants born at early gestations. There has been little corresponding decrease in long-term complications. As a result, additional stresses are placed on neonatal intensive care units across the country, impacting families, health care professionals, and society as a whole. Moral distress and moral residue are often cited in the neonatal-perinatal literature as stressors experienced by those who participate in the resuscitation decision-making process. They are directly related to the challenge of making a concrete decision about life and death at extremely early gestations in the context of long-term uncertainty. In this review, we performed a systematic search of medical and ethics ...
In Search of Consistency: Scandinavian Approaches to Resuscitation of Extremely Preterm Infants
Pediatrics
Guidelines around the resuscitation of extremely preterm infants have been developed, in part, to ensure consistency in decision-making between hospitals and health professionals. However, such guidelines can also be used to highlight other forms of inconsistency: between countries and between practices in different areas of medicine. In this article, we highlight the ethical advantages (and disadvantages) of consistency. We argue that an internationally uniform approach to ethically complex decisions is neither likely nor desirable.
Paediatrics & child health, 2007
To describe resuscitation decisions and withdrawal of treatment practices in live-born infants at the extremes of prematurity at St Joseph's Health Care (London, Ontario). A retrospective chart review was conducted on all neonatal deaths between 22 weeks, zero days' and 25 weeks, six days' gestational age over an eight-year period. Documentation concerning end-of-life discussions was subjected to thematic review to limit or withhold resuscitation or withdraw treatment. Three hundred eighteen infants were delivered between 22 weeks, zero days' and 25 weeks, six days' gestational age. Of these, 21% of infants (67 of 318) were stillborn, 38% (121 of 318) were alive on discharge from hospital and 41% (130 of 318) died in the neonatal period. Of the live-born infants who did not survive to discharge, 34% (44 of 130) had no initial attempts at resuscitation. Withdrawal of life-sustaining treatment was the immediate cause of death in 84% of cases (61 of 73) in which the...