Ethical considerations in neonatal respiratory care.
Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant's demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units.
Orzalesi
Marcello
M
Bambino Gesù Children's Hospital, Rome, Italy. orzalesi@opbg.net
Cuttini
Marina
M
D000328:Adult; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D005066:Euthanasia, Passive / Q000941:ethics*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000941:ethics*; D008297:Male; D010290:Parents; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012123:Pulmonary Ventilation / Q000941:ethics
D011663:Pulmonary Surfactants