Abstract

This article presents a philosophical framework for physician-family ethical decision-making for the controversial cases of withdrawal, initiation, or continuation of treatment for spina bifida infants. The well-known criteria for selective treatment proposed by Lorber are shown to be ethically sub-optimal on the grounds that they are based on a general conception of the decision framework that is open to serious criticisms and questioning.We propose a model of joint physician-family decision-making that we think represents a more rational method of balancing patient autonomy with the professional expertise and international moral norms of physicians. We raise serious reservations about the wisdom of allowing the state to intervene too strenously in this type of decision, in many cases.