Critical care decisions in fetal and neonatal medicine: ethical issues
The context for decision making in fetal and neonatal care
3.1 In fetal and neonatal medicine, there are several stages at which decisions have to be made that may determine whether a baby lives or dies. How such decisions are made, and the way in which ethical principles guide decision making are the focus of this Report. Yet ethical principles cannot be considered in isolation if they are to make a difference to practice. For example, we concluded in Chapter 2 that a baby’s best interests are central to decision making. However, his or her interests are bound up with those of his or her family and can be
difficult to determine in isolation. It is therefore essential that the medical, social and legal frameworks for critical care decisions before and after birth are well understood. That is the purpose of this chapter.
3.2 We begin by considering how rates of infant survival and low birthweight have changed over the past 50 years. We then set out the clinical context for pregnancy, birth, babies born at the borderline of viability,1and for babies where complications or abnormalities are present after birth. Following this, we consider how social and cultural factors may influence families and healthcare professionals in decision making. Some of the possible consequences of critical care decisions for a child and his or her family, including practical issues upon leaving hospital, coming to terms with possible disability, and the impact on his or her quality of life, are described. Finally, we present a brief outline of the economic and legal context.
Footnotes1 In this Report we use the term ‘borderline of viability’ to refer to babies born up to 25 weeks, six days of gestation. By convention, the number of weeks of gestation refers to the period from the first to the last day of that week. For example ‘at 23 weeks’ means from 23 weeks to 23 weeks, six days of gestation (161–167 days of gestation).