David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jonathan Jenkins Ichikawa
Jack Alan Reynolds
Learn more about PhilPapers
Bioethics 23 (9):503-514 (2009)
In many forms of severe acute brain injury there is an early phase when prognosis is uncertain, followed later by physiological recovery and the possibility of more certain predictions of future impairment. There may be a window of opportunity for withdrawal of life support early, but if decisions are delayed there is the risk that the patient will survive with severe impairment. In this paper I focus on the example of neonatal encephalopathy and the question of the timing of prognostic tests and decisions to continue or to withdraw life-sustaining treatment. Should testing be performed early or later; and how should parents decide what to do given the conflicting values at stake? I apply decision theory to the problem, using sensitivity analysis to assess how different features of the tests or different values would affect a decision to perform early or late prognostic testing. I draw some general conclusions from this model for decisions about the timing of testing in neonatal encephalopathy. Finally I consider possible solutions to the problem posed by the window of opportunity. Decision theory highlights the costs of uncertainty. This may prompt further research into improving prognostic tests. But it may also prompt us to reconsider our current attitudes towards the palliative care of newborn infants predicted to be severely impaired.
|Keywords||clinical ethics hypoxia‐ischemia decision theory brain withdrawing treatment newborn Infant|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
Dominic Wilkinson (2009). The Self-Fulfilling Prophecy in Intensive Care. Theoretical Medicine and Bioethics 30 (6):401-410.
Anita Silvers & Leslie Francis (2011). Cloudy Crystal Balls Do Not “Gray” Babies Make. American Journal of Bioethics 11 (2):36 - 38.
Similar books and articles
David Hunt & Seth Shabo (2013). Frankfurt Cases and the (in)Significance of Timing: A Defense of the Buffering Strategy. Philosophical Studies 164 (3):599-622.
Felix Thiele (2003). Genetic Tests in the Insurance System: Criteria for a Moral Evaluation. Poiesis and Praxis 1 (3):185-195.
Arthur R. Derse (1999). Making Decisions About Life-Sustaining Medical Treatment in Patients with Dementia. Theoretical Medicine and Bioethics 20 (1):55-67.
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.
Virginia A. Moyer Ned Calonge Steven M. Teutsch Jeffrey R. Botkin (2008). Expanding Newborn Screening: Process, Policy, and Priorities. Hastings Center Report 38 (3):pp. 32-39.
Alexander Kon (2009). The “Window of Opportunity:” Helping Parents Make the Most Difficult Decision They Will Ever Face Using an Informed Non-Dissent Model. American Journal of Bioethics 9 (4):55-56.
Robert M. Sade (2011). The Locus of Decision Making for Severely Impaired Newborn Infants. American Journal of Bioethics 11 (2):39 - 40.
Jørgen Hilden & J. Dik F. Habbema (1987). Prognosis in Medicine: An Analysis of its Meaning and Rôles. Theoretical Medicine and Bioethics 8 (3).
Dominic Wilkinson (2011). Should We Replace Disabled Newborn Infants? Journal of Moral Philosophy 8 (3):390-414.
Added to index2009-10-01
Total downloads25 ( #167,791 of 1,938,583 )
Recent downloads (6 months)7 ( #83,335 of 1,938,583 )
How can I increase my downloads?