Ethical concerns involving the newborns at risk
Authors:
B. Zlatohlávková
Authors‘ workplace:
Ústav humanitních studií v lékařství, UK 1. LF, Praha
přednosta doc. ThDr. V. Ventura, Th. D.
; Novorozenecké oddělení Gynekologicko–porodnické kliniky, VFN a UK 1. LF, Praha
primář prof. MUDr. R. Plavka, CSc.
Published in:
Čes-slov Pediat 2014; 69 (5): 319-327.
Category:
Ethics
Overview
In most cases ethical decision-making regarding neonates who require intensive care can be based upon the four primary bioethical principles – beneficence, nonmaleficence, respect for autonomy and justice. Because a newborn lacks such autonomy in the sense of freedom of choice decisions are made by the infant’s surrogates (most often parents) according to the best interests standard. In most cases parents and physicians come to a mutual agreement that does not jeopardize the interests of the child; only exceptionally in urgent situations it is possible or necessary to overcome the authority of the parents. Decisions in cases of chronically ill newborns and infants with congenital defects are not made in situations of emergency and an integral part of these decisions is the evaluation of the possible future quality of life. Decision-making about offering intensive care at the threshold of viability between 22–25 weeks of gestation cannot be entirely based upon existing principles and rules. These decisions are made in uncertainty. We are unable to predict with certainty the viability of an unborn child. We cannot forecast the consequences of our decision, nevertheless, we must decide. We have an objective medical uncertainty based upon insufficient knowledge and the lack of strong evidence regarding correct management. Out of this objective medical uncertainty comes subjective moral uncertainty. Even when we try to specify and balance the four bioethical principles we cannot reach a satisfactory solution. The source of our deepest uncertainty is the absence of a basic rule by which we could justify whether or not to initiate intensive care. The most righteous approach is to decide upon each child as a unique living being albeit the risk that we would have acted differently had we known the result beforehand. A decision made in uncertainty cannot be decided according a fixed standard of care because it would not withstand basic ethical requirements.
Key words:
ethical decission-making, principles of biomedical ethics, newborn, viability, intensive care, uncertainty Z.
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Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2014 Issue 5
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