Faculty Collaboration Database

Decisions regarding resuscitation of the extremely premature infant and models of best interest. J Perinatol 2001;21(3):193-8

Date

08/15/2001

Pubmed ID

11503107

DOI

10.1038/sj.jp.7200523

Scopus ID

2-s2.0-0034871437 (requires institutional sign-in at Scopus site)   56 Citations

Abstract

Differences concerning the care of an extremely premature infant may stem from alternative points of view on how to determine the infant's best interest. These alternatives are illustrated by differences between recently published statements by the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn (COFN) and the Committee on Bioethics (COB). The statements agree that a goal of neonatal medicine is to minimize both under- and overtreatment of the extremely premature infant, and advocate that the decision-making process ought to be based on the concept of the premature infant's best interest. However, the two AAP Committees appear to diverge in how they operationalize the concept of an infant's best interest. The COFN adopts a process consistent with an "expertise" model of best interest, while the COB process is consistent with a "negotiated" model. In the "expertise" model, medical re-evaluation of the infant's status, the best outcome data available, and the treating physician's best medical judgment determine best interest. This model limits parental and societal input, and can lead a physician to act paternalistically. In the "negotiated" model, best interest is determined by outcome data and physician assessment, as well as the moral value of an outcome. This model maximizes parental input, accepts physicians as moral agents, and respects social influence in a decision. It is important to clarify one's model of best interest to help understand the differences of opinion regarding decisions based on best interest. The negotiated model of best interest is a more ethically appropriate model to approach decision making.

Author List

Leuthner SR

Author

Steven R. Leuthner MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Decision Making
Decision Support Techniques
Female
Humans
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal
Male
Parents
Practice Guidelines as Topic
Resuscitation
United States