David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
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Theoretical Medicine and Bioethics 28 (5):393-412 (2007)
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.
|Keywords||neonatology NICU ethics newborns ELBW death parental authority pediatrics|
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References found in this work BETA
Paul Ramsey (1978). Ethics at the Edges of Life: Medical and Legal Intersections. Yale University Press.
Nancy K. Rhoden (1986). Treating Baby Doe: The Ethics of Uncertainty. Hastings Center Report 16 (4):34-42.
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Citations of this work BETA
Dominic James Wilkinson (2011). A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants. American Journal of Bioethics 11 (2):20 - 32.
Rosalind McDougall, Lauren Notini & Jessica Phillips (2015). Conflicts Between Parents and Health Professionals About a Child’s Medical Treatment: Using Clinical Ethics Records to Find Gaps in the Bioethics Literature. Journal of Bioethical Inquiry 12 (3):429-436.
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