Naissances très prématurées : dilemmes et propositions de prise en charge. Seconde partie : enjeux éthiques, principes de prise en charge et recommandations

Moriette, G; Rameix, S.; Azria, Élie; Fournié, A; Andrini, P; Caeymaex, Laurence; Dageville, C.; Gold, F.; Kuhn, Pierre; Storme, Laurent; Siméoni, Umberto

doi:10.1016/j.arcped.2009.09.024

Cited by 66 publications

(27 citation statements)

References 13 publications

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“…The working group recommends a much more direct parental involvement when decisions must be taken during the prenatal period, in particular for premature babies at the borderline of viability [6,7] . This aspect of the question is, however, beyond the scope of this article.…”

Section: Parental Role In the Decision-making Processmentioning

confidence: 99%

“…The working group therefore refrained from setting forth any rigid recommendations based on a quasiautomatic consideration of gestational age and/or birth weight for the management of children born at the borderline of viability [6,7] . Recommendations of the NCB go along the same lines [9] .…”

Section: Individual Medical Responsibilitymentioning

confidence: 99%

“…The multidisciplinary Working Group on Ethical Issues in Perinatal Medicine (for a list of its members, see the Appendix), composed of neonatologists, obstetricians and ethicists, was established for this purpose. It has published articles in French medical journals on topics including: ethical issues which arise when delivering information to parents in the context of perinatal care [5] , management of births at the threshold of viability [6,7] , and ethical issues related to end-of-life situations in neonatology [8] .…”

Section: Introductionmentioning

confidence: 99%

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The French Society of Neonatology’s Proposals for Neonatal End-of-Life Decision-Making

Dageville¹,

Bétrémieux

Gold

et al. 2011

Neonatology

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Background: Opinions and practice regarding end-of-life decisions in neonatal medicine show considerable variations between countries. A recent change of the legal framework, together with an ongoing debate among French neonatologists, led the French Society of Neonatology to reconsider and update its previous recommendations. Objectives: To propose a set of recommendations on the ethical principles to be respected in the making and application of end-of-life decisions. Methods: A multidisciplinary working group on ethical issues in perinatal medicine composed of neonatologists, obstetricians and ethicists. Results: Withholding or withdrawing life-sustaining treatment may be acceptable, and unreasonable therapeutic obstinacy is condemned. This implies that the child’s best interests must always be the central consideration. Although the parents must be involved in the decision process so that they form an alliance with the healthcare team, and a collegial approach is of utmost importance, any crucial decision affecting the patient’s life calls for individual medical responsibility. Because every newborn is rightfully an integral member of a human family, his or her dignity must be preserved. The goal of palliative care is to preserve the quality of a life, also at its end. The intention underlying an act has to be analyzed perceptively. Euthanasia, i.e. to perform an act with the deliberate intention to cause or hasten a patient’s death, is legally and morally forbidden. Conversely, to withhold or withdraw a life-sustaining treatment can be justified when the intention is to cease opposing, in an unreasonable manner, the natural course of a disease. Conclusions: This statement provides the principles identified by French neonatologists on which to base their decisions concerning the ending of life. Arguments are set forth, discussed and compared with international statements and previously published considerations.

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Section: Parental Role In the Decision-making Processmentioning

confidence: 99%

Section: Individual Medical Responsibilitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The French Society of Neonatology’s Proposals for Neonatal End-of-Life Decision-Making

Dageville¹,

Bétrémieux

Gold

et al. 2011

Neonatology

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“…Crisis situation decision making in the delivery room can be difficult for both parents and physicians 8. Parents, as opposed to health-care professionals, usually want intervention to save the infant, irrespective of birth weight or condition at birth.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Ethical dilemmas in decision making at limits of neonatal viability

Nadroo¹

2012

J Islam Med Assoc

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The survival rate for extremely preterm infants has improved over the last two decades. Although the incidence of such births is about 2%, the impact of preterm birth on these infants, their families, health-care providers, and society is profound. The birth of an extremely low birth weight (ELBW) and early gestational age infant poses complex medical, social, and ethical challenges to the family and health-care professionals. Survivors have an increased risk of chronic medical problems and disability. It is difficult to make decisions while trying to provide optimal medical care to the infant and supporting the family when delivery occurs at the threshold of viability because outcome at that time is highly unpredictable. Such decisions may have lifelong consequences for those involved.An individualized prognostic strategy appears to be the most appropriate approach. While keeping the patient’s best interest as the primary objective, the goal is to reach, through a process of effective communication between the parents and physicians, a consensual decision that respects the parents’ wishes and promotes physician beneficence.

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“…C'est une question difficile car, au fil des années de l'étude, la population des nouveaux-nés a évolué avec la prise en charge d'enfants d'âge gestationnel de plus en plus bas qui décé-daient auparavant (23, 24 et 25 SA) et le fait que certains enfants gravement atteints, prématurés ou non, qui décé-daient en début de période d'étude ont survécu avec le progrès des soins. Par ailleurs, cette évaluation doit aussi tenir compte des arrêts de soins ou, plus précisément, de la mise en place de soins palliatifs durant cette période[16][17][18]. Il faut donc suivre les incidences en stratifiant selon l'âge gestationnel et la gravité de l'état des nouveaux-nés en néonatologie.…”

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Réseau de suivi des enfants vulnérables dans les Pays de la Loire (Grandir Ensemble – Cohorte LIFT) : dix ans d’activité de 2003 à 2013

Branger¹,

Rouger²,

Berlie³

et al. 2015

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Naissances très prématurées : dilemmes et propositions de prise en charge. Seconde partie : enjeux éthiques, principes de prise en charge et recommandations

Cited by 66 publications

References 13 publications

The French Society of Neonatology’s Proposals for Neonatal End-of-Life Decision-Making

The French Society of Neonatology’s Proposals for Neonatal End-of-Life Decision-Making

Ethical dilemmas in decision making at limits of neonatal viability

Réseau de suivi des enfants vulnérables dans les Pays de la Loire (Grandir Ensemble – Cohorte LIFT) : dix ans d’activité de 2003 à 2013

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