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Medicine's increased capacities make intervention at all stages of pregnancy and labour both more common and more successful. The capacity to see the developing fetus in the womb and the skills of healthcare professionals around the moment of birth, when coupled with the sophistication of their knowledge about fetal development, genetics and safe delivery, also enhance the professionals' perceived responsibility to the child-to-be as well as to the mother.
Generally speaking this is likely to be both uncontroversial and welcome. Most pregnant women (and their partners) are likely to view the progress in prenatal screening and managed childbirth as being a definite bonus, increasing their reproductive liberties and maximising the safety of pregnancy and childbirth. Undoubtedly, in the vast majority of cases this will be the experience of women and their partners. However, this is not to say that the modern management of pregnancy is entirely uncontroversial, and – perhaps unfortunately – it is necessary to consider such controversy in this chapter. These controversies are often intimately linked to the primary focus of this chapter; namely issues surrounding consent and negligence.
It is widely accepted that – except in limited circumstances – consent is a prerequisite of both an ethical and a legal intervention. In an emergency situation where consent cannot be sought because of the patient's lack of consciousness, treatment may proceed without the patient's consent.
The delivery of a preterm infant can produce some of the most difficult practical challenges in obstetric and paediatric practice, amply illustrated by other chapters in this book. However, these practical challenges must at the same time proceed with consideration for the perhaps even greater challenge of deciding whether what can be done, should be done. Ordinarily, as explained in the previous chapter, decisions about acceptable medical care are expected to be taken in partnership between patients and their healthcare team, with patients setting limits on the care that they would find acceptable and that which they do not feel would be appropriate for them. Where decisions must be made on behalf of others, in this case premature babies, deciding what interventions should be attempted and when treatment should be discontinued needs the utmost care and transparency, since we cannot appeal to respecting the autonomous wishes of the individual as the touchstone for commencing or ceasing treatment.
When making such decisions, there is an inevitable tension between the desire to do everything possible to save the life of a vulnerable new person and the equally strong desire to avoid causing pain and distress or allowing suffering to continue without prospect of improvement. The way in which these sometimes opposing convictions are resolved is through attempting to weigh up the relative burdens and benefits of treatment to the child and reaching a conclusion on what course of action will cause the child the greatest benefit or the least harm.
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