(N Engl J Med. 2018;379:1851–1860)
Disagreements regarding life-sustaining treatments in the neonatal intensive care unit (NICU) are not uncommon, especially when parental requests conflict with doctor recommendations. Cases that are intractable often end up in court, where outcomes can vary depending on state statutes. Ethicists have developed a general framework, first articulated in 1983, for balancing the child’s interest with the scope of parental authority. When benefits of treatment are clear, the baby’s right to treatment outweighs parental rights. When benefits of treatment are less clear, ethicists and courts often defer to parental choice. Nevertheless, gray zones still exist in conflict resolution. A new approach, emerging in the early 2000s, proposes that rather than only providing detailed, objective information, doctors help parents discern their own values and ethical commitments in these unanticipated situations. In this review, the author discussed this shift in approach and how advances in both prenatal diagnosis and neonatal therapeutics can change treatments and perspectives in the NICU.
OBJECTIVES: This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. METHODS: Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin use. RESULTS: The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01). CONCLUSIONS: When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction--evidence that they are consuming more heroin.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.