Law and ethics at the border of viability

Krug, Ernest F.

doi:10.1038/sj.jp.7211529

Cited by 10 publications

(7 citation statements)

References 10 publications

(9 reference statements)

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“…[11][12][13][14][15][16] It is difficult for parents to make rational, responsible decisions about medical care without some understanding of complex medical outcomes data. The process of information exchange and dialogue is often carried out in a maelstrom of cultural and religious diversity, physical stress, confusing technologic concepts, and the fundamental human desire for offspring.…”

Section: Discussionmentioning

confidence: 99%

Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes

et al. 2009

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Rational, consensus periviability guidelines are well accepted and can be used by all neonatologists, obstetricians, and nurses who provide care to pregnant women and infants at extremely early gestational ages. Pregnant women see these guidelines as highly understandable, useful, consistent, and respectful. When encouraged to participate with attending staff in discussions involving morbidity and mortality outcomes of premature infants and consensus medical practice recommendations, a substantial proportion of parents will choose palliative comfort care for their extremely premature infant up through 25 weeks' postmenstrual age. We believe the choice of neonatal intensive care versus palliative comfort care in extremely premature infants rightfully belongs to medically informed parents. More research is needed to examine how these decisions are made under diverse conditions of culture, religion, and technology.

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Section: Discussionmentioning

confidence: 99%

Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes

et al. 2009

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“…There is a fairly extensive discussion in middle- and high-income countries surrounding the ethical significance of thresholds of viability and the definitions of "prematurity" and "extreme prematurity" [4,5]. This discussion remains controversial.…”

Section: Resultsmentioning

confidence: 99%

Global report on preterm birth and stillbirth (6 of 7): ethical considerations

Kelley

Rubens

2010

BMC Pregnancy Childbirth

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IntroductionDespite the substantial global burden of preterm and stillbirth, little attention has been given to the ethical considerations related to research and interventions in the global context. Ethical dilemmas surrounding reproductive decisions and the care of preterm newborns impact the delivery of interventions, and are not well understood in low-resource settings. Issues such as how to address the moral and cultural attitudes surrounding stillbirths, have cross-cutting implications for global visibility of the disease burden. This analysis identifies ethical issues impacting definitions, discovery, development, and delivery of effective interventions to decrease the global burden of preterm birth and stillbirth.MethodsThis review is based on a comprehensive literature review; an ethical analysis of other articles within this global report; and discussions with GAPPS's Scientific Advisory Council, team of international investigators, and a community of international experts on maternal, newborn, and child health and bioethics from the 2009 International Conference on Prematurity and Stillbirth. The literature review includes articles in PubMed, Academic Search Complete (EBSCO), and Philosopher's Index with a range of 1995-2008.ResultsAdvancements in discovery science relating to preterm birth and stillbirth require careful consideration in the design and use of repositories containing maternal specimens and data. Equally important is the need to improve clinical translation from basic science research to delivery of interventions, and to ensure global needs inform discovery science agenda-setting. Ethical issues in the development of interventions include a need to balance immediate versus long-term impacts—such as caring for preterm newborns rather than preventing preterm births. The delivery of interventions must address: women's health disparities as determinants of preterm birth and stillbirth; improving measurements of impact on equity in coverage; balancing maternal and newborn outcomes in choosing interventions; and understanding the personal and cross-cultural experiences of preterm birth and stillbirth among women, families and communities.ConclusionEfforts to improve visibility, funding, research and the successful delivery of interventions for preterm birth and stillbirth face a number of ethical concerns. Thoughtful input from those in health policy, bioethics and international research ethics helped shape an interdisciplinary global action agenda to prevent preterm birth and stillbirth.

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“…Opting for palliative management or a limited treatment is possible with families in an ambience of mutual understanding and friendliness, a long way from the medical paternalism that was still common a few years ago. Ethicists and health care providers now widely recognise parents as playing a fully active part in health decisions concerning their infant [16,[25][26][27][28][29]. Knowing how to share this information more effectively still requires further research.…”

Section: Discussionmentioning

confidence: 99%