Critical care decisions in fetal and neonatal medicine: ethical issues

The principle of ‘best interests’ is central to medical practice and UK law. It states that in all matters affecting any child his or her best interests should be the paramount consideration.

We conclude

Any decision made in respect of the child must carefully consider the interests of all potentially affected persons, most usually other family members, old or young, who will live with the child or are dependent upon the immediate family in other ways. However the best interests of the baby should be the central consideration and carry the greatest weight.

Parents, doctors and others involved in the decision making process may have different ideas about what is in the best interests of the baby.

Clarifying how best interests are judged would be helpful. We suggest that when a decision must be made about whether or not to institute, withhold or withdraw treatment from a baby after birth, a number of questions should be considered, including:

• What degree of pain, suffering and mental distress will the treatment inflict on the child?
• What benefits will the future child get from the treatment, for example, will the child be able to survive independently of life support, be capable of establishing relationships with other people, and be able to experience pleasure of any kind?
• What kind of support is likely to be available to provide the optimum care for the child?
• What are the views and feelings of the parents as to the interests of the baby?
• For how much longer is it likely that the baby will survive if life-sustaining treatment is continued?