Most neonates who now survive intensive care would have died 50 years ago, and “nature” would have decided the outcomes, making ethical discussions about initiating or withholding resuscitation irrelevant. Medical developments in neonatology have changed the way we respond to diseases of neonates, to their illness, and to their parents. Not only as physicians, but also as a society.
Decisions on when to start, withhold, or withdraw life-saving interventions in critically ill neonates are among the most difficult decisions in pediatric practice. These decisions are fraught with ethical dilemmas, for example deciding whether withholding intensive care –leading to death- is superior to uncertain survival with a risk of disability and the additional burden of intensive care. This book covers important ethical questions that arise in neonatal intensive care units. Questions such as, whether to intervene medically and whether we are good at predicting the outcome of fragile neonates; whether a medical intervention should be withheld or withdrawn, and who should be primarily responsible for these decisions and how?
Table of Content
Contents; 1 Introduction; John Lantos.- 2 How babies die and why this is important to clinicians, researchers, and parents; Eduard Verhagen and Annie Janvier.- 3 When do we become a person and why should it matter to pediatricians?; Amélie Dupont-Thibodeau and Annie Janvier.- 4 Neonates are devalued compared to older patients; Annie Janvier, Carlo Bellieni and Keith Barrington.- 5 Who makes it to the NICU? The association between prenatal decisions and neonatal outcomes; Amélie Dupont-Thibodeau and Annie Janvier.- 6 Termination of pregnancy and perinatal palliative care in the case of fetal anomaly: why is there so much incoherence?; Antoine Payot.- 7 Predicting outcomes in the very preterm infant; Keith Barrington.- 8 Predicting the future of preterm infants: should we use quality of life and social determinants criteria?; Antoine Payot.- 9 End-of-life decisions in neonatology from a children’s rights perspective: Dutch developments examined; Jozef Dorscheidt.- 10 The Lure of Technology: Considerations in Newborns with Technology-Dependence; Brian Carter.- 11 Making tough ethical choices in a morally pluralistic world; John Lantos.
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