Abstract
Potential conflict exists when parents refuse a medical intervention for their child that the physician feels obligated to provide. For the anticipated delivery of a preterm newborn, this conflict might exist if the parents refuse resuscitation. At borderline viability, most neonatologists are likely to respect the parents' wishes. However, there will be some gestational age threshold above which the physician will feel compelled to resuscitate despite parental refusal, and will be ethically justified in doing so. The location of that threshold should be determined by the application of sound ethical reasoning, rather than relying on habit or arbitrary standards. That reasoning should include an honest assessment of the benefits and burdens to the child, short-term and long-term, of attempted resuscitation, made in light of relevant mortality and morbidity data. However, a rational analysis will also require consideration of whether the patient's best interest standard should be strictly applied, or whether the interests of others, such as family members, should also be taken into account.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Neonatologists’ decision-making for resuscitation and non-resuscitation of extremely preterm infants: ethical principles, challenges, and strategies—a qualitative study
BMC Medical Ethics Open Access 25 September 2021
-
The theorisation of ‘best interests’ in bioethical accounts of decision-making
BMC Medical Ethics Open Access 01 June 2021
-
Global report on preterm birth and stillbirth (6 of 7): ethical considerations
BMC Pregnancy and Childbirth Open Access 23 February 2010
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Mercurio MR . Physicians' refusal to resuscitate at borderline gestational age. J Perinatol 2005; 25: 685–689.
Cummings B, McKay K, Hussain N . Neonatologists' opinions regarding resuscitation of extremely premature infants in Connecticut and Rhode Island. Connecticut Med 2002; 66: 733–738.
Lorenz JM . The outcome of extreme prematurity. Semin Perinatol 2001; 25: 348–359.
Jones HP, Karuri S, Cronin CM, Ohlsson A, Peliowski A, Synnes A et al. Actuarial survival of a large Canadian cohort of preterm infants. BMC Pediatr 2005; 5: 40.
MacDonald H, the Committee on Fetus and Newborn. Perinatal care at the threshold of viability. Pediatrics 2002; 110: 1024–1027.
Hack M, Taylor G, Drotar D, Schluchter M, Cartar L, Wilson-Costello D et al. Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age. Pediatrics 2005; 116: 333–341.
Marlow N, Wolke D, Bracewell M, Samara M, for the EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. New Engl J Med 2005; 352: 9–19.
Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O et al. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1886–1997. Pediatrics 2005; 116: 1391–1400.
Wood N, Marlow N, Costeloe K, Gibson A, Wilkinson A for the EPICure Study Group. Neurologic and developmental disability after extremely preterm birth. New Enlg J Med 2000; 343: 378–384.
Magriples U, Copel J . Obstetric management in the high risk patient. In: Burrow GN, Duffy TP, Copel J (eds). Medical Complications During Pregnancy, 6th edn. Elsevier Saunders: Philadelphia, 2004, pp 1–14.
Tyson J, Younes N, Verter J, Wright L . Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight. JAMA 276; 20: 1645–1661.
Beauchamp T, Childress J . Principles of Biomedical Ethics. Oxford University Press: New York, 1994 pp 120–188.
Schloendorf V . Society of New York hospital, 1914, as quoted. In McCullough LB, Chervenak FA (eds). Ethics in Obstetrics and Gynecology. Oxford University Press: New York, 1994, p 50.
Paris JJ, Schreiber MD . Parental discretion in refusal of treatment for newborns: a real but limited right. Clin Perinatol 1996; 23: 573–581.
Engelhardt HT . Ethical issues in aiding the death of young children. In Kohl M (ed). Beneficent Euthanasia. Prometheus Books: Buffalo, 1975, p 185.
American Academy of Pediatrics Committee on Fetus and Newborn. The initiation or withdrawal of treatment for high-risk newborns. Pediatrics 1995; 96: 362–363.
Taber's Cyclopedic Medical Dictionary. F.A. Davis: Philadelphia, 2001 p 2062.
Buchanan AE, Brock DW . Deciding for Others. Cambridge University Press: New York, 1990, pp 112–133.
American Academy of Pediatrics. Guidelines on forgoing life-sustaining medical treatment. Pediatrics 1994; 93: 532–536.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. U.S. Government Printing Office: Washington, 1983 p 218.
Harwig J . What about the family? In: Harwig J (ed). Is there a Duty to Die? and Other Essays in Medical Ethics. Routledge: New York, 2000, pp 29–44.
Acknowledgements
Thanks to Carl Bose for suggesting the article, to Rich Ehrenkranz for the Yale data, and to Steve Peterec for critical review and suggestions.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mercurio, M. Parental authority, patient's best interest and refusal of resuscitation at borderline gestational age. J Perinatol 26, 452–457 (2006). https://doi.org/10.1038/sj.jp.7211547
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211547
Keywords
This article is cited by
-
Neonatologists’ decision-making for resuscitation and non-resuscitation of extremely preterm infants: ethical principles, challenges, and strategies—a qualitative study
BMC Medical Ethics (2021)
-
The theorisation of ‘best interests’ in bioethical accounts of decision-making
BMC Medical Ethics (2021)
-
Global report on preterm birth and stillbirth (6 of 7): ethical considerations
BMC Pregnancy and Childbirth (2010)
-
Positionspapier zur Begrenzung lebenserhaltender Therapie im Kindes- und Jugendalter
Monatsschrift Kinderheilkunde (2009)