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Lethality begets lethality

Journal of Perinatology volume 31, pages 630–631 (2011)Cite this article

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Courtwright et al.1 report that the diagnosis of ‘lethal’ conditions prenatally leads to care that is less intense, lower cost and of similar survival benefit when compared with postnatally diagnosed cases. Based on these results, the authors conclude that ‘highly aggressive interventions did not prolong survival in these cases and should not be offered.’ Based on such a definitive assessment one would assume that despite aggressive efforts to support infants after a lethal diagnosis, there was no significant prolongation of life. The authors do not report data that would allow such a determination to be made. Given the lack of such data, the phenomenon of the self-fulfilling prophecy (SFP) is a likely explanation for the authors' findings.

The SFP describes a situation in which a false description of a circumstance evokes behavior that makes the original false conception come true. ‘The specious validity of the self-fulfilling prophecy perpetuates a reign of error.’2 In intensive care, the SFP is apparent in decisions related to withdrawal of life support on the basis of high predicted mortality. In such cases there may be a possibility of a lethal outcome, but the likelihood for lethality increases as a result of prediction, which is not true. As regards predicting a condition is lethal, potentially lifesaving treatments are withheld. As a result, patients who might have survived will then die, perpetuating the belief that the condition is lethal.2

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  1. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, UNC Hospital, Chapel Hill, NC, USA

    M J McCaffrey

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  1. M J McCaffrey
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Correspondence to M J McCaffrey.

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McCaffrey, M. Lethality begets lethality. J Perinatol 31, 630–631 (2011). https://doi.org/10.1038/jp.2011.52

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