End-of-life decision before and after birth: changing ethical considerations

Pintér, Andrew

doi:10.1016/j.jpedsurg.2007.09.054

Cited by 25 publications

(18 citation statements)

References 24 publications

(17 reference statements)

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“…3,4,5,7,18,19,20 Our mortality rates, however, might have been confounded by withholding medical treatment from these infants given the dual risks of major chromosomal anomaly and VLBW. Although offering intensive management for infants with T21 is standard treatment, 21,22 the decision to implement or continue invasive or other life-sustaining procedures among infants with T18 or T13 is a complex decision dependent on input from the family, family supporters, involved healthcare workers and sometimes bioethicists and/or independent guardians of the infant. Although some have indicated that cardiac surgery is not appropriate for these infants as they die of conditions unrelated to their cardiac defects, 5,20,23 others have argued that cardiac surgery and the related intensive treatment are ethically acceptable as they can alleviate their symptoms and prolong their survival.…”

Section: Discussionmentioning

confidence: 99%

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

Boghossian

Horbar

Carpenter

et al. 2012

The Journal of Pediatrics

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Objective To examine prevalence, characteristics, interventions and mortality of VLBW infants with trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13) or triploidy. Study design Infants with birth weight 401–1500 g admitted to centers of the Vermont Oxford Network during 1994–2009 were studied. A majority of the analyses are presented as descriptive data. Median survival times and their 95% CIs were estimated using the Kaplan-Meier approach. Results Of 539509 VLBW infants, 1681 (0.31%) were diagnosed with T21, 1416 (0.26%) with T18, 435 (0.08%) with T13, and 116 (0.02%) with triploidy. Infants with T18 were the most likely to be growth restricted (79.7%). Major surgery was reported for 30.4% of infants with T21, 9.2% with T18, 6.4% with T13, and 4.8% with triploidy. Hospital mortality occurred among 33.1% of infants with T21, 89.0% with T18, 92.4% with T13, and 90.5% with triploidy. Median survival time was 4 days (95% CI, 3–4) among infants with T18 and 3 days (95% CI, 2–4) among both infants with T13 and infants with triploidy. Conclusion In this cohort of VLBW infants, survival among infants with T18, T13 or triploidy was very poor. This information can be used to counsel families.

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Section: Discussionmentioning

confidence: 99%

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

Boghossian

Horbar

Carpenter

et al. 2012

The Journal of Pediatrics

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“…Broadly phrased as above, the neonatal intensive care bioethical dilemma's resolution may be reached within a frame of two opposing positions: the intrinsic value of human life on the one hand and the quality of life on the other [14][15][16][17]. For the supporters of the intrinsic value of human life position, life should be protected by all means and at any cost, irrespective of its quality.…”

Section: Introductionmentioning

confidence: 99%

Ethical issues in NICUs: The Attitude of Greek Healthcare Professionals Towards the Value of Human Life

Δάγλα¹,

Petousi²,

Πούλιος³

2017

Health Care Current Reviews

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Objective: This paper presents the first Greek empirical research on bioethical neonatal issues. The study goals were: 1) to document and measure the attitude of Greek healthcare professionals' working in NICUs towards the value of human life (intrinsic value vs. quality of life) as ethical decision making guiding principle in the provision of intensive treatment to extremely/very preterm babies and 2) to investigate the socio-cultural and other parameters which form this attitude. Methods:Questionnaires developed for the EURONIC project and implemented in research in 11 countries were culturally adjusted to the Greek NICU context. Healthcare professionals (n=495) who were employed in Greek NICUs (May 2009-May 2011 and met inclusion criteria were invited to participate. Of those 251 (98 midwives, 82 nurses and 71 doctors) completed a structured, self-administered, anonymous questionnaire (response rate 50.7%). Results:The reported attitude score (total sample mean attitude score=3.09) indicates that Greek healthcare professionals tend to support the intrinsic value of human life position. Gender (p<0.05), the importance placed on religion (p<0.05) and profession specialization (p<0.01) were found to influence their attitude in statistically significant ways. Specifically, men, professionals who consider religion as being important in their life and midwives and nurses tend to be more supportive of the intrinsic value of life position. NICUs' equipment and personnel, the cost of neonatal healthcare provision, and the burden of disability on the neonate's family have not been found to influence healthcare professionals' attitude in statistically significant ways. Conclusion:Compared to the findings from other countries in which the EURONIC research was implemented, Greek healthcare professionals appear to hold a rather vitalistic approach and follow the intrinsic value of human life position as their ethical decision-making guiding principle. Socio-cultural and professional characteristics explain ethical decision making differences among healthcare professionals.

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“…However, the termination of pregnancy has been performed in many European countries, even after 24 weeks of pregnancy, because of the presence of fetal abnormalities, because fetal abnormalities are clearly characterized as one of the indications for terminating the pregnancy [4,14,15]. Pinter [16] described the guidelines for surgical treatments by dividing fetuses and neonates into 6 groups according to the severity of their malformations from patients who are likely to be completely cured by surgery to the patients who have malformations that are not compatible with leading a healthy life.…”

Section: Discussionmentioning

confidence: 99%

Current status of negative treatment decision-making for fetuses with a prenatal diagnosis of neonatal surgical disease at a single Japanese institution

Usui

Kanagawa

Kamiyama

et al. 2010

Journal of Pediatric Surgery

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End-of-life decision before and after birth: changing ethical considerations

Cited by 25 publications

References 24 publications

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

Ethical issues in NICUs: The Attitude of Greek Healthcare Professionals Towards the Value of Human Life

Current status of negative treatment decision-making for fetuses with a prenatal diagnosis of neonatal surgical disease at a single Japanese institution

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