Critical care decisions in fetal and neonatal medicine: ethical issues
Dilemmas in current practice: babies needing itensive care
Introduction
6.1 We have seen in the preceding chapters that in the UK, current practice rests on a consensus that if the outcome for a baby with a serious condition is uncertain after birth, life support and full intensive care should be instituted until the prognosis becomes clearer and the situation re-evaluated. This stage may be reached when the results of investigations are known, or after a period when the clinical situation changes, or even when the baby’s parents have had some time to adjust to a diagnosis and prognosis. In this chapter, we focus on the very serious conditions that can lead parents and healthcare professionals to begin discussing whether intensive care should be continued or be withdrawn. Some babies in intensive care may have started life at the borderline of viability. Others may have been born later, but with serious health problems. The relief of discomfort and pain is an important consideration, whether during intensive care or as part of palliative care when intensive care treatment has been replaced with other forms of care. As before, we use hypothetical examples to illustrate the dilemmas that parents and professionals face in making decisions when a poor prognosis for a baby has been established.1We highlight some economic issues relating to critical care decisions after birth, although we have not been able to find sufficient data to compare the economic costs of outcomes for children who start life with different conditions, as we would have wished. Finally, we discuss the importance of data collection and analysis to help reduce uncertainty in the prediction of health outcomes.
Footnotes1 We use examples that are representative of what occurs in hospital. They are not based on clinical cases. In the discussion of each example, issues are highlighted, some of which were drawn to the attention of members of the Working Party during fact-finding meetings. We acknowledge that the choice of the issues that we discuss after each example may influence how the examples themselves are perceived by different readers, depending upon the reader’s own worldview.