Physicians are morally required to provide effective therapy for children. Conversely, parents are theoretically empowered to refuse effective therapy for their children. However, in practice, parents are only able to exercise this power if they are offered the option; that is, if the physicians perceive of the care as at least falling within a “grey zone” of parental discretion. We analyzed 101 responses obtained in survey of physicians attending a postgraduate course regarding their preference of resuscitation at birth of infants <1000 gm. We asked if they would offer full resuscitation(FR), only comfort care (CC) or defer to parents' wishes (Parent), for four distinct weight groups (table). We also asked if their decision was influenced by infant factors (viability (via), futility (fut) and quality of life (Qlty)) or by social factors (resource utilization (RU), litigation (Lit) or religious beliefs (RB)). Results: For infants <500 g 60% preferred comfort care, 30% deferred to parents wishes. The most common reason to withhold resuscitation was poor viability/futility. For larger infants quality of life concern predominated. For infants >600 g full resuscitation was the major choice (>90%). For infants 500-600 gm, 70% preferred full resuscitation. Only 17% deferred to parents wishes. Surprisingly, concerns regarding resource utilization, litigation and religious beliefs in deciding no resuscitation for <500 gm and full resuscitation for >500 gm played minimal role. Despite the potential complications in survivors of 600-1000 gm, only a minority of neonatologists would defer to parental wishes. In 1990's the “grey zone” of parental discretion appears to be between 500-600 gm.

Table 1
Full size table