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Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne

Abstract

Most extremely premature infants die in the intensive care unit or suffer significant neurologic impairment. Many therapies result in unhealthy consequences, and the emotional and financial turmoil for families warrant reappraisal of our motives. Shared decision-making and informed consent in preference-sensitive conditions imply the family: (a) understands the medical problem, (b) grasps the risks and benefits of each therapy, (c) has the opportunity to ask questions and reflect upon options, (d) knows their values and preferences are understood, and (e) accepts or declines therapies without judgment or penalty. Mandatory resuscitation of premature infants or inflexible palliative comfort care policies are inconsistent with the principles of informed consent and shared decision-making. Physicians should emulate the Greek ideal of sophrosyne—virtue inherent to balance, reasoned limits, freedom but restraint, and humility. Informed choice is fundamental to liberty; evidence-based periviability guidelines and decision aids bolstered by structured informed consent ensure process integrity.

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Acknowledgements

We thank Gautham Suresh, MD (Section Head and Chief of Neonatology, Texas Children’s Hospital, Houston, TX) for his critical review of this manuscript. Manuscript preparation was supported by the Providence Health and Services Foundation (Portland, OR). The sponsor had no role in the content of this analysis and commentary. The authors have no financial relationships relevant to this article to disclose.

Author contributions

Dr. Kaempf conceptualized and drafted the first version of the manuscript, table, and figure, and reviewed the manuscript, all references, and final version. Mr. Dirksen reviewed and helped revise the manuscript, table and figure, reference review, and participated in the final version revision. Both authors take responsibility for the integrity and accuracy of this analysis and commentary. Both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Joseph W. Kaempf.

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Kaempf, J., Dirksen, K. Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne. J Perinatol 38, 306–310 (2018). https://doi.org/10.1038/s41372-017-0024-4

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