ETH-038: Decision-Making for High-Risk Newborns
Decision-Making for High-Risk Newborns: The Wisconsin Medical Society recognizes the extremely difficult circumstances under which decisions must be made regarding care for newborns at the edge of viability. In such circumstances there is a difficult dilemma: intensive treatment of all severely ill infants may result in prolongation of dying accompanied by significant discomfort for the infant or in survival with unacceptable quality of life; on the other hand, non-intensive treatment may result in increased mortality and morbidity. Either approach risks undesired and unpredictable results. The Society therefore supports the following principles:
- Treatment decisions must be guided primarily by the best interest of the child.
- Direct and open communication between the health care team and the parents of the child with regard to the medical status, prognosis, and treatment options is essential; parents must be included as active participants in the decision process. When a poor prognosis is anticipated, discussion between parents and physicians should, if possible, begin before the birth of a child.
- Physicians should present prognostic information in a frank and balanced way, without coercion, and with sensitivity to parents’ complex concerns and desires. Ongoing evaluation of the condition and prognosis of the high-risk infant is essential, and second opinions may often prove beneficial.
- Physicians and parents should consider the benefits and burdens of continuing treatment and prolonging life.
- The decision to initiate or continue intensive care should be based only on the judgment that the infant will benefit from the intensive care. It is inappropriate for life-prolonging treatment to be continued when the condition is incompatible with life or when the treatment is judged to be harmful, of no benefit, or futile.
- In all cases, comfort care should be continued even when intensive care is not being provided.
The Society expresses its grave concerns with the Court’s opinion in Montalvo v. Borkovec, MD, 2002, that “in the absence of persistent vegetative state, the right of a parent to withhold life-sustaining medical treatment does not exist,” and supports remedies to the decision in line with the principles above.
The Society also encourages all physicians to utilize current evidence-based statistics as they relate to prognoses for high-risk newborns, and supports the efforts of the American Academy of Pediatrics, Neonatal Research Network and others to disseminate prognostic information to physicians. (HOD, 0414)