Archives of Disease in Childhood - Fetal and Neonatal Edition 2008;93:F332-F335
LEADING ARTICLES
Decisions for life made in the perinatal period: who decides and on which standards?
1 Rosie Hospital, Addenbrooke’s NHS Trust, Cambridge, UK
2 Boston College, Chestnut Hill, MA 02467, USA
Jag Ahluwalia, Rosie Hospital, Addenbrooke’s NHS Trust, Hills Road, Cambridge CB2 0QQ, UK; jag.ahluwalia@addenbrookes.nhs.uk
Accepted 23 May 2008
| The first 150 words of the full text of this article appear below. |
Central to the purpose of perinatal medicine and neonatal care are three clinical aims: to save the lives of infants with treatable conditions, to minimise needless suffering and indignity, and to maximise the quality of life in survivors. The report of the Nuffield Council on Bioethics on "Critical care decisions in fetal and neonatal medicine"1 and the policy statement of the American Academy of Pediatrics (AAP) on "Noninitiation or withdrawal of intensive care for high-risk newborns"2 remind us of the difficulties, both ethical and clinical, in trying to achieve these goals for infants born at the threshold of viability. This paper explores the key factors in decision making in this area: Who decides on whether or not to initiate aggressive treatment? Who determines when to stop? What standards, if any, should guide such choices? Whose view prevails when there is a conflict over treatment between the physician and the parents?
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