Neonatal Ethics Flashcards
What are the two exceptions to the rule of following the principles of ethics?
- Life threatening medical emergencies
- When patients are not competent to make their own decisions
What are the AMA’s guidelines in regarding to medical interventions for the fetus?
- Must pose minimal risk to woman’s health
- Minimal invasion
- High probability of preventing substantial, irreversible fetal harm
True or false: According to the ACOG, every effort should be made to protect the fetus, but the pregnant woman’s autonomy should be respected
True
According to the ACOG, should judicial authority be used to implement treatment regimens aimed at protecting the fetus?
No
What is the current trend of anti-abortion measures?
Advancing the idea that a fetus has a right to life over the mother
What was the opinion issued by the AAP committee on fetal therapy in 1999?
The medical team should offer a multidisciplinary, collaborative approach to directly communicate with the pregnant woman and her partner
According to the the AAP committee on fetal therapy in 1999, you should consider opposing a woman’s refusal of intervention only when what three conditions are met?
- The intervention has been shown to be effective
- There is reasonable certainty that the fetus will suffer substantial harm without the intervention
- The risk to the health and well-being of the pregnant woman is negligible
What is the expertise model that existed in the past in terms of the role of physicians in decision making, and the newer negotiated model?
Expertise = dr knows best
Negotiated = Incorporates parental values and input throughout decision making process
Should the gestational age of the fetus, as well as the regional morbidity/mortality statistics play a role in the decision making process for determining the interventions for an extremely early fetus?
Yes
Are there ethical guidelines on the clinical approach to resuscitation and treatment at birth?
No
What is the primary determinant of survival of a fetus?
gestational age
True or false: there is little variation on the survival rate of fetuses amongst different hospitals
False–wide variations exist
What is the accuracy of US in determining GA?
+/- 5 days
What is the dilemma of a cut off in delivering babies based on GA?
Variability in accuracy of dating.
You should never make a firm commitment regarding supportive measures for a baby until what?
You have the opportunity to examine it
What is the key factors that constitutes ethical medical practice?
The health care team needs to show unified and non-judgemental support of the parents
ROM for how long is a risk factor for the development of chorioamnionitis?
Greater than 18 hours
What were the outcomes of the NEJM study in 2015 regarding premature infants being treated?
All preterm infants not receiving care diet within 24 hours of birth
-All infants born before 22 weeks gestation died within 12 hours, even with treatment
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What is the current canadian guideline for treating infants at 22 weeks gestation?
no intervention until 23 weeks (changed from giving parents the option at 22)
What are the recommendations of the AAP NRP in 2000 regarding the care of premature infants? What changed in 2014?
No care for less than 23. between 23-24, selective care based on parents request
Those born at 23 weeks should be considered potentially viable
What is the recommendation per the british regarding caring for less than 22, 22-24, and more than 25 weeks? Per (2006 guidelines)
Less than 22 weeks no resuscitation
Gray area for 22-24
More than 25 weeks should attempt resuscitation
What has happened to the morbidity and mortality of very premature births?
Mortality has dropped, but the morbidities have remained largely unchanged
What is the AMA code of medical ethics in terms of making decisions regarding life-sustaining treatment for seriously ill newborns?
The primary consideration for decisions regarding life-sustaining treatment for seriously ill newborns should be what is best for the newborn
What is the child rehabilitation act of 1973?
Regardless of the infant’s potential quality of life, feasible therapies must be performed if there is a medical need
What is the child abuse prevention and treatment act of 1984?
Drs must give treatment, unless would prolong dying, or be futile
What is the born-alive infants protection act of 2002?
Defined birth as any stage of development, where the infant breathes, or has a beating heart
What is the federal law that mandates delivery room resuscitation in all circumstances?
There is no such law
What is the no hope and no purpose situations where it is ethical to not initiate resuscitation?
No hope = medically futile
No purpose = high morbidity
Is it appropriate to resuscitate an infant against a parent’s wishes, if you think it is medically viable to do so?
Yes
Should you resuscitate an infant who you did not initially resuscitate d/t earlier agreement if the parents suddenly decide they want the child minutes after not doing anything?
No–results in significant morbidity
What are the components of the three box model?
- Unreasonable to insist on continued treatment
- Unreasonable to refuse treatment
- Physicians defer to surrogate’s decision
