Abstract
There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant’s deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions.
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Acknowledgements
Earlier versions of this work have been presented at the Hastings Center, the Medical University of South Carolina, the Department of Philosophy at the University of Hawaii at Manoa, the annual meeting of the Society for Bioethics Consultation, and Kapiolani Medical Center in Honolulu. Many have participated in its evolution. Appreciation is especially owed to Lainie Friedman Ross, M.D., Ph.D.; David Easa, M.D.; Bruce Jennings, Alan R. Fleischman, M.D., Lisa Newton, Ph.D., Larry B. McCullough, Ph.D., Daniel Murai, M.D., Susan R. Martyn, J.D., Ruth Guffee, Ellen Moskowitz, J.D., Harvey Kipnis, Tracy Garvie, Helen Smalley-Bower, Doug Diekema, M.D., Amber Orr, J.D., Julia Morgan, J.D., Leanne Logan, John Constancio Licato and Carson Strong. The author is deeply grateful to the Hawaii Council for the Humanities for its early support, and to the Hastings Center for making available resources that facilitated much of the research that went into this paper.
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Kipnis, K. Harm and Uncertainty In Newborn Intensive Care. Theor Med Bioeth 28, 393–412 (2007). https://doi.org/10.1007/s11017-007-9051-z
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DOI: https://doi.org/10.1007/s11017-007-9051-z