Neonatal Ethics

Question 1

What are the two exceptions to the rule of following the principles of ethics?

Answer 1

• Life threatening medical emergencies

- When patients are not competent to make their own decisions

Question 2

What are the AMA’s guidelines in regarding to medical interventions for the fetus?

Answer 2

• Must pose minimal risk to woman’s health
• Minimal invasion
• High probability of preventing substantial, irreversible fetal harm

Question 3

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

Answer 3

True

Question 4

According to the ACOG, should judicial authority be used to implement treatment regimens aimed at protecting the fetus?

Answer 4

No

Question 5

What is the current trend of anti-abortion measures?

Answer 5

Advancing the idea that a fetus has a right to life over the mother

Question 6

What was the opinion issued by the AAP committee on fetal therapy in 1999?

Answer 6

The medical team should offer a multidisciplinary, collaborative approach to directly communicate with the pregnant woman and her partner

Question 7

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?

Answer 7

• 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

Question 8

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?

Answer 8

Expertise = dr knows best

Negotiated = Incorporates parental values and input throughout decision making process

Question 9

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?

Answer 9

Yes

Question 10

Are there ethical guidelines on the clinical approach to resuscitation and treatment at birth?

Answer 10

No

Question 11

What is the primary determinant of survival of a fetus?

Answer 11

gestational age

Question 12

True or false: there is little variation on the survival rate of fetuses amongst different hospitals

Answer 12

False–wide variations exist

Question 13

What is the accuracy of US in determining GA?

Answer 13

+/- 5 days

Question 14

What is the dilemma of a cut off in delivering babies based on GA?

Answer 14

Variability in accuracy of dating.

Question 15

You should never make a firm commitment regarding supportive measures for a baby until what?

Answer 15

You have the opportunity to examine it

Question 16

What is the key factors that constitutes ethical medical practice?

Answer 16

The health care team needs to show unified and non-judgemental support of the parents

Question 17

ROM for how long is a risk factor for the development of chorioamnionitis?

Answer 17

Greater than 18 hours

Question 18

What were the outcomes of the NEJM study in 2015 regarding premature infants being treated?

Answer 18

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

-

Question 19

What is the current canadian guideline for treating infants at 22 weeks gestation?

Answer 19

no intervention until 23 weeks (changed from giving parents the option at 22)

Question 20

What are the recommendations of the AAP NRP in 2000 regarding the care of premature infants? What changed in 2014?

Answer 20

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

Question 21

What is the recommendation per the british regarding caring for less than 22, 22-24, and more than 25 weeks? Per (2006 guidelines)

Answer 21

Less than 22 weeks no resuscitation

Gray area for 22-24

More than 25 weeks should attempt resuscitation

Question 22

What has happened to the morbidity and mortality of very premature births?

Answer 22

Mortality has dropped, but the morbidities have remained largely unchanged

Question 23

What is the AMA code of medical ethics in terms of making decisions regarding life-sustaining treatment for seriously ill newborns?

Answer 23

The primary consideration for decisions regarding life-sustaining treatment for seriously ill newborns should be what is best for the newborn

Question 24

What is the child rehabilitation act of 1973?

Answer 24

Regardless of the infant’s potential quality of life, feasible therapies must be performed if there is a medical need

Question 25

What is the child abuse prevention and treatment act of 1984?

Answer 25

Drs must give treatment, unless would prolong dying, or be futile

Question 26

What is the born-alive infants protection act of 2002?

Answer 26

Defined birth as any stage of development, where the infant breathes, or has a beating heart

Question 27

What is the federal law that mandates delivery room resuscitation in all circumstances?

Answer 27

There is no such law

Question 28

What is the no hope and no purpose situations where it is ethical to not initiate resuscitation?

Answer 28

No hope = medically futile

No purpose = high morbidity

Question 29

Is it appropriate to resuscitate an infant against a parent’s wishes, if you think it is medically viable to do so?

Answer 29

Yes

Question 30

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?

Answer 30

No–results in significant morbidity

Question 31

What are the components of the three box model?

Answer 31

• Unreasonable to insist on continued treatment
• Unreasonable to refuse treatment
• Physicians defer to surrogate’s decision