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The Lazarus case, Life and Death Issues in Neonatal Intensive Care
  1. Forrester Cockburn

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When things go badly wrong in the perinatal period there has developed a culture in many “advanced societies” that demands a search for someone to blame. This search for guilt, accountability, punishment, and recompense often results in litigation.

In this thought provoking book John D Lantos describes such lawsuits as “our public morality plays” and uses his experience as a neonatologist, expert witness, and ethicist to create, debate, and crystallise relevant issues of ethics related to the neonatal intensive care of a fictional preterm infant who should have died but did not—The Lazarus Case.

A fictitious neonatologist, Dr Miller, decides to stop resuscitation of a very preterm infant who seems past reasonable care. The baby who might have died survived with severe neurological problems and the parents sue Dr Miller, alleging that stopping treatment was negligent. John Lantos places himself in the role of expert witness and uses questions put by the plaintiff’s lawyers to explore the moral, ethical, legal, and social factors and to illustrate the ambiguities, misunderstandings, responsibilities, and evasions highlighted by the perinatal care of a 25 week gestation infant.

A key question put to Dr Lantos by one lawyer was “Can studying philosophy tell you whether what a doctor does in a particular case is right or wrong?” Probably not is the final conclusion reached by Dr Lantos, but it was just as unlikely that definitive guidance would come from sociology, religious doctrine, strict medical protocols, or any other single source.

There have been many attempts over the past half century to face and explain the moral dilemmas associated with our attempts to save the lives, prevent damage, and encourage optimal development of critically ill preterm infants. The Lazarus Case reviews in a most effective, compelling, erudite, and compassionate way the enormous complexity of these issues. It is highly recommended to all who are concerned with the care of preterm infants and their families and is essential reading for those required to provide medicolegal advice on life and death issues in neonatal intensive care.