Moral and Ethical Dilemmas in Critically Ill Newborns: A 20-Year Follow-Up Survey of Massachusetts Pediatricians

Abstract

Surveys of Massachusetts pediatricians in the 1970s and 1980s indicated changing attitudes concerning life-saving treatment of newborns, from less to increased intervention.

OBJECTIVE:

To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates.

STUDY DESIGN:

A long-term follow-up survey of American Academy of Pediatrics Massachusetts membership, maintaining the 1987 instrument, was initiated.

RESULTS:

A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians’ attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making.

CONCLUSION: This study indicates stability and consensus in pediatricians’ attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy.