ethics of neonatology Flashcards
who should decide whether to intervene with neonates
Parent(s)? Clinicians? Managers? Ethicists? Society? Judges?
what does the UK say about beginning of treatment in premature babies
RCPCH states each case should be determined on its merits not gestational age
what does the USA say about beginning of treatment in premature babies
American Academy of Pediatrics advocates non-initiation of resuscitation before 23 weeks
what does the Netherlands say about beginning of treatment in premature babies
infants born before 25 weeks gestation are not treated on the grounds of ‘poor prognosis’
law regarding neonatal treatment
Case law on paediatric decision making has generally supported clinical opinion being the determinative opinion on what constitutes ‘best interests
Withdrawing / withholding treatment in cases of clinical futility is lawful
In 9 month audit 84% of NICU/PICU deaths resulted from withdrawing/withholding treatment
Legal rationale is distinction between ‘killing’ (active) and ‘letting die’ (passive) [?ethics?]
In neonatology, it will inevitably be ‘non-voluntary’
how are best interests determined
Potential to develop awareness
Ability to interact and capacity for self-direction
Child likely to endure unavoidable pain and suffering
Weighing the net benefit of treatment cf: non-treatment
