Infants born at the borderline of viability pose difficult ethical questions because of poor survival rates and the possibility of long-term disability1.
The Nuffield Council guidelines for resuscitation practice2 emphasise the need to consider each case individually.
The four principles approach to medical ethics3 provides a basis for individual case decision-making as follows:
The principle of respect for autonomy recognises the rights and responsibilities of parents as surrogate decision-makers, although this right is qualified by the need to act in the best interests of their child;
The principles of beneficence and non-maleficence prioritise the ‘best interests’ standard by incorporating quality-of-life assessments, and if necessary by limiting the authority of the parents;
The principle of justice addresses the wider result of decisions and the interests of the child within the family.
The role of the clinician within the clinician/parent partnership is twofold: firstly to inform the parents by communicating clinical knowledge and experience, and secondly to provide support for the family through professional values and trust.
Conclusion Weighting the four principles of medical ethics with a focus on the best interests of the child provides a flexible and simple means to address each borderline viability infant case on an individual basis and reach the best ethical solution.
Moore T, Hennessey EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, Marlow N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961
Nuffield Council on Bioethics. Dilemmas in current practise: babies born at the borderline of viability. Critical care decisions in foetal and neonatal medicine: ethical issues. London: Nuffield Council; 2006. http://www.nuffieldbioethics.org/neonatal- medicine (accessed 27/09/2012) p 67–87
Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994; 309: 184–188.
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