Ethical problems regarding extremely preterm infants

. Gynakol Geburtshilfliche Rundsch 44 (1): 25--30 (January 2004)


In the industrialized countries during the last 20 years, ever smaller preterm infants have been re-animated after birth, subjected to mechanical ventilation, fed parenterally and treated with various drugs. The smaller and more premature the infant, the longer the intensive care, the greater pain and suffering for the infants concerned and the worse the long-term results. Although mortality decreased, chronic problems of the lungs, eyes and brain (cerebral palsy) increased in the surviving infants. Therefore specialists as well as the general public began to discuss the limits of using intensive medicine. Investigations among neonatologists and nursing staff all over Europe resulted in a wide spectrum of opinions where the line should be drawn, e.g. concerning gestational age. A majority is however in favour of stopping intensive care measures when these are not in the best interest of the infant, i.e. when treatment becomes painful and inescapable death is only postponed. In order to reach such a difficult medico-ethical decision in a structured, understandable and well-supported way, special procedures were developed, which have stood their test in practice.

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