Ethical Considerations in Neonatal Respiratory Care

Ethical problems in the care of high risk neonates

Recent progress in neonatal care has greatly improved the prognosis and the probabilities of survival in very sick or very preterm neonates and has modified the concept and limits of the so called viability. However, in some circumstances, when the death of the baby can only be postponed temporarily, at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and the family, then it might not be appropriate to utilize all the armamentarium of neonatal intensive care. In such circumstances, limitation of intensive treatments (withholding or withdrawal) generally invasive and painful, could represent a more human and reasonable alternative. The ethical principles underlying those decisions, the most frequent situations occurring in practice, the role of parents in the decision-making process, and the opinions and behavior of neonatologists from many European intensive care units will be examined and discussed.

When newborn infants are bound to die

Withholding and withdrawing of intensive care of severely ill newborns may occasionally be needed when there is severe injury and extremely poor prognosis. In such cases, strict guidelines and procedures should be followed. In this issue of Acta Paediatrica, Arlettaz et al. describe such guidelines and report practice from the University Hospital in Zürich. To ensure an unbiased discussion, it is important that those who make decisions regularly receive input from external sources regarding indications of viability. This may be the case if, for instance, a unit has decided that the limit of viability is <26 wk, and many children with good life expectancy would in such units be denied intensive care. Does a liberal view on withholding or withdrawing treatment lead to poorer overall outcome results even for babies above the threshold of viability specified by the institution?

CONCLUSION

Strict procedures should be followed in the case of withholding or withdrawing intensive care of severely ill newborn infants. In every institution, the indications for ending life should be discussed on a regular basis, preferably with external input. However, euthanasia of newborn infants is not compatible with Western cultural traditions and should be abandoned.