Neonatologists and bioethics after Baby Doe.
The use of hospital ethics committees or infant care review committees has been recommended for difficult decision making. In a survey of military and civilian neonatologists, ethics committees had been established in 27 of their 28 hospitals and fewer than 50% had infant care review committees. Despite the frequently of potential cases for committee review, they were seldom consulted. Inquiry into the educational background of respondents revealed that at least 62% of neonatologists had received ethics education during their professional careers. Most made difficult decisions in conjunction with parents or used a multidisciplinary patient care conference. The use of these conferences antedated any federal regulations. Sixty-seven percent indicated that the Baby Doe regulations had affected neither their thinking about ethical issues nor their practice. In 13 different hypothetical cases in delivery room, intensive care nursery, and long-term care settings, the provision of comfort care, limited care, or withdrawal of support was noted by a sizable percentage of neonatologists; exceptions included meningomyelocele and trisomy 21. The need for ethics committee input in decision making for neonates is questionable.
Department of Pediatrics, Fitzsimmons Army Medical Center, Aurora, CO 80045.
B S
BS
Carter
D001291:Attitude of Health Personnel; D000013:Congenital Abnormalities / Q000628:therapy*; D017041:Ethics Committees; D028741:Ethics Committees, Clinical; D033061:Ethics Consultation; D004992:Ethics, Medical; D035082:Federal Government; D033161:Government Regulation; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008020:Life Support Care / Q000706:statistics & numerical data; D008887:Military Medicine / Q000592:standards / Q000706:statistics & numerical data; D009359:Neonatology / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D010380:Peer Review; D011795:Surveys and Questionnaires; D014481:United States; D028761:Withholding Treatment