Moral and ethical dilemmas in critically ill newborns: a 20-year follow-up survey of Massachusetts pediatricians.
OBJECTIVE
To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates.


METHODS
A long-term follow-up survey of American Academy of Pediatrics Massachusetts membership, maintaining the 1987 instrument, was initiated.


RESULTS
A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians' attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making.


CONCLUSIONS
This study indicates stability and consensus in pediatricians' attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy.
Todres
I D
ID
Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
Guillemin
J
J
Catlin
E A
EA
Marlow
A
A
Nordstrom
A
A
D000328:Adult; D001002:Anuria / Q000628:therapy; D001291:Attitude of Health Personnel; D016638:Critical Illness / Q000628:therapy; D003625:Data Collection; D003863:Depression / Q000628:therapy; D004992:Ethics, Medical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D007235:Infant, Premature, Diseases / Q000628:therapy; D008020:Life Support Care / Q000592:standards / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009014:Morals; D009136:Muscular Dystrophies / Q000628:therapy; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data