Abstract
“I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” The Hippocratic oath expressed beneficence and non-maleficence as basic principles of medical ethics more than 2000 years ago. Beneficence in perinatal and neonatal medicine refers to the responsibility of the physicians to act in the “best interests” of the fetus and newborn infant. Non-maleficence relates to the avoidance of harm to the fetus and infant but also to the mother. This implies that the benefit of treatments should outweigh the harm and risks of the treatment for the patient.
Similar content being viewed by others
References
American Academy of Pediatrics (2007) Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 119:401–403
Batton DG, Committee on Fetus and Newborn (2009) Clinical report—Antenatal counseling regarding resuscitation at an extremely low gestational age. Pediatrics 124:422–427
Bellieni CV, Buonocore G (2009) Flaws in the assessment of the best interests of the newborn. Acta Paediatr 98:613–617
Bilgen H, Topuzoglu A, Kuscu K et al (2007) End-of-life decisions in the newborn period: attitudes and practices of doctors and nurses. Turk J Pediatr 51:248–256
Boss RD, Hutton N, Sulpar LJ et al (2008) Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns. Pediatrics 122:583–589
Boyle RJ (2004) Ethical issues in the care of the neonate. NeoReviews 5:e471–e476
Byrne S, Szyld E, Kattwinkel J (2008) The ethics of delivery-room resuscitation. Semin Fetal Neonatal Med 13:440–447
Carter BS (2004) Comfort care principles for the high-risk newborn. NeoReviews 5:e484–e490
Chiswick M (2008) Infants at borderline viability: ethical and clinical consideration. Semin Fetal Neonatal Med 13:8–15
Comitato Nazionale per la Bioetica (2008) I grandi prematuri. Note bioetiche. [EP babies. Bioethical notes]. www.governo.it/bioetica
Cuttini M, Casotto V, Vonderweid U et al (2009) Neonatal end-of-life decisions and bioethical perspectives. Early Hum Dev 85:S21–S25
Dare T (2009) Parental rights and medical decisions. Pediatr Anesth 19:947–952
De Leeuw R, Cuttini M, Nadai M et al (2000) Treatment choices for extremely preterm infants: an international perspective. J Pediatr 137:608–616
Dehan M, Gold F, Grassin M et al (2001) Dilemmes éthiques de la période périnatale: recommendations pour les decisions de fin de vie. Arch Pediatr 8:407–419
Dunn PM (1990) Life saving intervention in the neonatal period: dilemmas and decisions. Arch Dis Child 65:557–558
Fanaroff AA (2008) Extremely low birthweight infants-the interplay between outcomes and ethics. Acta Paediatr 97:144–145
Finer NN, Tarin T, Vaucher YE et al (1999) Intact survival in extremely low birth weight infants after delivery room resuscitation. Pediatrics 104:e40
Fischer N, Steurer MA, Adams M et al (2009) Survival rates of extremely preterm infants (gestational age <26 weeks) in Switzerland: impact of the Swiss guidelines for the care of infants born at the limit of viability. Arch Dis Child Fetal Neonatal Ed 94:F407–F413
Griswold KJ, Fanaroff JM (2010) An evidence-based overview of prenatal consultation with a focus on infants born at the limits of viability. Pediatrics 125:e931–e937
Hakansson S, Farooqi A, Holmgren PA et al (2004) Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics 114:58–64
Halamek LP (2003) Prenatal consultation at the limits of viability. NeoReviews 4:e153–e156
Harrison HT (2008) The offer they can’t refuse: parents and perinatal treatment decisions. Semin Fetal Neonatal Med 13:329–334
Hayward MF, Murphy RO, Lorenz JM (2008) Message framing and perinatal decisions. Pediatrics 122:109–118
Henley A, Judith Schot J (2008) The death of a baby before, during or shortly after birth: good practice from the parents’ perspective. Semin Fetal Neonatal Med 13:325–328
Hentschel R, Lindner K, Krueger M, Reiter-Theil S (2006) Restriction of ongoing intensive care in neonates: a prospective study. Pediatrics 118:563–569
Hester DM (2007) Interests and neonates: there is more to the story than we explicitly acknowledge. Theor Med Bioeth 28:357–372
Iijima S, Arai H, Ozawa Y et al (2009) Clinical patterns in extremely preterm (22 to 24 weeks of gestation) infants in relation to survival time and prognosis. Am J Perinatol 26:399–406
Ikeda K, Hayashida S, Hokuto I (2006) International perspectives: recent outcomes of ultrapreterm and extremely low-birth weight infants. Neo Reviews 7:e511–e516
Isaacs D, Kilham H, Gordon A et al (2006) Withdrawal of neonatal mechanical ventilation against the parents’ wishes. J Paediatr Child Health 42:311–315
Itabashi K, Horiuchi T, Kusuda S et al (2009) Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics 123:445–450
Jankov RP, Asztalos EV, Scidmore MB (2000) Favourable neurological outcomes following delivery room cardiopulmonary resuscitation of infants ≤750 g at birth. J Paediatr Child Health 36:19–22
Janvier A, Barrington KJ (2005) The ethics of neonatal resuscitation at the margins of viability: informed consent and outcomes. J Pediatr 147:579–585
Janvier A, Bauer KL, Lantos JD (2007) Are newborns morally different from older children? Theor Med Bioeth 28:413–425
Janvier A, Lantos J, Deschènes M et al (2008a) Caregivers attitudes for very premature infants: what if they knew? Acta Paediatr 97:276–279
Janvier A, Leblanc I, Barrington KJ (2008b) The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrics 121:963–969
Janvier A, Leblanc I, Barrington KJ (2008c) Nobody likes premies: the relative value of patients’ life. J Perinatol 28:821–826
Kaempf JW, Tomlinson MW, Campbell B et al (2009) Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics 123:1509–1515
Kipnis K (2007) Harm and uncertainty in newborn intensive care. Theor Med Bioeth 28:393–412
Kopelman LM (2007) The best interests standard for incompetent or incapacitated persons of all ages. J Law Med Ethics 35:187–196
Kusuda S, Fujimura M, Sakuma I et al (2006) Morbidity and mortality of infants with very low birth weight in Japan. center variation. Pediatrics 118:e1131–e1139
Ladd RE, Mercurio MR (2003) Deciding for neonates: whose authority, whose interests? Semin Perinatol 27:488–494
Lagercrantz H, Changeux JP (2009) The emergence of human consciousness: from fetal to neonatal life. Pediatr Res 65:255–260
Lam HS, Wong SPS, Liu FYB et al (2009) Attitudes toward neonatal intensive care treatment of preterm infants with a high risk of developing long-term disabilities. Pediatrics 123:1501–1508
Lavin JP, Kantak A, Ohlinger J et al (2006) Attitudes of obstetric and pediatric health care providers toward resuscitation of infants who are born at the margins of viability. Pediatrics 118:S169–S176
Levene M (2004) Is intensive care for very immature babies justified? Acta Paediatr 93:149–152
Leversen KT, Sommerfelt K, Rønnestad A et al (2011) Prediction of neurodevelopmental and sensory outcome at 5 years in Norwegian children born extremely preterm. Pediatrics 127:e630–e638
Linderkamp O (2012) Survival and outcome of extremely preterm infants in the 90s and early 2000s. Acta Paediatr (in press)
Lui K, Bajuk B, Foster K et al (2006) Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop. Med J Aust 185:495–500
MacDonald H, American Academy of Pediatrics Committee on Fetus and Newborn (2002) Perinatal care at the threshold of viability. Pediatrics 110:1024–1027
Markestad T, Kaaresen PI, Ronnestad A et al (2005) Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 15:1289–1298
Marsal K, Express Group (2009) Survival of extremely preterm infants after active perinatal care in Sweden. JAMA 301:2225–2233
Martinez AM, Partridge JC, Yu V et al (2006) Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim. J Paediatr Child Health 41:209–214
Meadow W, Frain L, Ren Y et al (2002) Serial assessment of mortality in the neonatal intensive care unit by algorithm and intuition: certainty, uncertainty, and informed consent. Pediatrics 109:878–886
Mercurio MR (2009) The ethics of newborn resuscitation. Semin Perinatol 33:354–363
Miljeteig I, Markestad T, Norheim OF (2007) Physicians’ use of guidelines and attitudes to withholding and withdrawing treatment for extremely premature neonates in Norway. Acta Paediatr 96:825–829
Moser K, Macfarlane A, Chow YH et al (2007) Introducing new data on gestation-specific infant mortality among babies born in 2005 in England and Wales. Health Stat Q 35:13–27
Nishida H, Sakuma I (2009) Limit of viability in Japan: ethical consideration. J Perinat Med 37:457–460
Nuffield Council on Bioethics (2006) Critical care decisions in fetal and neonatal medicine: ethical issues, London. www.nuffieldbioethics.org/neonatal-medicine
Österreichische Gesellschaft für Kinder-und Jugendheilkunde (2005) Erstversorgung von Frühgeborenen an der Grenze der Lebensfähigkeit. Monatsschr Kinderheilkd 7:711–715
Partridge JC, Dickey BJ (2009) Decision-making in neonatal intensive care: interventions on behalf of preterm infants. NeoReviews 10:e270–e278
Peerzada JM, Schollin J, Håkansson S (2006) Delivery room decision-making for extremely preterm infants in Sweden. Pediatrics 117:1988–1995
Pignotti MS, Donzelli G (2008a) Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics 121:e193–e198
Pohlandt F (2008) Leitlinie zur Frühgeburt an der Grenze der Lebensfähigkeit des Kindes. Monatsschr Kinderheilkd 156:798–802
Provost V, Deliens L, Cools F et al (2004) A classification of end-of-life decisions in neonates and infants. Acta Paediatr 93:301–305
Rennie JM, Leigh B (2008) The legal framework for end-of-life decisions in the UK. Semin Fetal Neonatal Med 13:296–300
Rijken M, Veen S, Walther FJ (2007) Ethics of maintaining preterm infants. Pediatr Child Health 17:58–63
Saigal S, Stoskopf B, Pinelli J et al (2006) Transition of extremely low birthweight infants from adolescence to young adulthood. Pediatrics 118:1140–1148
Seri I, Evans J (2008) Limits of viability: definition of the gray zone. J Perinatol Suppl 1:S4–S8
Singh J, Fanaroff J, Andrews B et al (2007) Resuscitation in the “gray zone” of viability: determining physician preferences and predicting infant outcomes. Pediatrics 120:519–526
Skupsi DW, McCullough B, Levene M, Chervenak FA (2010) Improving obstetric estimation of outcomes of extremely premature infants: an evolving challenge. J Perinat Med 38:19–22
The International Liaison Committee on Resuscitation (ILCOR) (2006) Consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics 117:e978–e988
Tripp J, McGregor D (2006) Withholding and withdrawing of life sustaining treatment in the newborn. Arch Dis Child Fetal Neonatal Ed 91:F67–F71
Turillazzi E, Fineschi V (2009) How old are you? Newborn gestational age discriminates neonatal resuscitation practices in the Italian debate. BMC Med Ethics 10:19
Tyson JE, Parikh NA, Langer J et al (2008) Intensive care for extreme prematurity-moving beyond gestational age. N Engl J Med 358:1672–1681
Verhagen E, Sauer PJJ (2005) The Groningen protocol-euthanasia in severely ill newborns. NEJM 352:959–992
Verhagen AAE, de Vos M, Dorscheidt JHHM et al (2009a) Conflicts about end-of-life decisions in NICUs in the Netherlands. Pediatrics 124:e112–e119
Verhagen AAE, Dorscheidt JHHM, Engels B et al (2009b) End-of-life decisions in Dutch neonatal intensive care units. Arch Pediatr Adolesc Med 163:895–901
Walter FJ (2005) Withholding treatment, withdrawing treatment, and palliative care in the neonatal intensive care unit. Early Hum Dev 81:865–872
Wilkinson AR, Ahluwalia J, Cole A et al (2009) Management of babies born extremely preterm at less than 25 weeks of gestation: a framework for clinical practices at the time of birth. Arch Dis Child Fetal Neonatal Ed 94:F2–F5
Wilson-Costello D, Friedman H, Minich N et al (2007) Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002. Pediatrics 119:37–45
World Health Organization (1993) International classification of diseases (ICD), vol 2, 10th rev edn. World Health Organization, Geneva, Switzerland
Wyatt JS (1999) Neonatal care: withholding or withdrawal of treatment in the newborn infant. Baillieres Best Pract Res Clin Obstet Gynaecol 13:503–511
Wyatt J (2007) End-of-life decisions, quality of life and the newborn. Acta Pædiatr 96:790–791
van Zuuren FJ, van Manen E (2006) Moral dilemmas in neonatology as experienced by health care practitioners: A qualitative approach. Med Health Care Philos 9:339–347
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this entry
Cite this entry
Linderkamp, O. (2017). Ethical Problems in Neonatal Medicine. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-18159-2_160-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-18159-2_160-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18159-2
Online ISBN: 978-3-319-18159-2
eBook Packages: Springer Reference MedicineReference Module Medicine