title: Ethics ain't easy: do we need simple rules for complicated ethical decisions?
abstract: BACKGROUND
  Recommendations from national bodies regarding extremely preterm infants have focussed almost exclusively on thresholds for intervention based upon estimated gestational age (GA) alone.
  
  
  METHODS
  We reviewed policy statements that address active intervention for newborn infants and compare them with those that are available for older patients. We reviewed research, examining attitudes towards preterm infants, uncertainties in GA assessment and other factors important in determining prognosis at the time of birth.
  
  
  RESULTS
  Policy statements regarding active care of very preterm infants treat this population differently from others in morally significant ways--without rationalizing this discrepancy. Extremely preterm infants are devalued in medical and lay opinion compared to older individuals with similar outcomes. Uncertainty in GA estimates often covers a range with vastly differing prognoses. Sex, birth weight, inborn-outborn status and use of antenatal steroids are vitally important in prognosis, but clinical findings in the delivery room are not. Most policy statements fail to account for these factors.
  
  
  CONCLUSIONS
  Simplistic policies based on GA alone should be avoided. Decision making for extremely preterm infants should recognize that they are each unique and must be individualized, taking into account all relevant prognostic factors and the values and wishes of the families.
authors: Paediatrics, McGill University, Montreal, Quebec, Canada.
authors: Annie
authors: A
authors: Janvier
authors: Keith J
authors: KJ
authors: Barrington
authors: Khalid
authors: K
authors: Aziz
authors: John
authors: J
authors: Lantos
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016414:Resuscitation Orders / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics