Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-18T05:24:41.176Z Has data issue: false hasContentIssue false
  • English
  • Français

The Marginally Viable Newborn: Legal Challenges, Conceptual Inadequacies, and Reasonableness

Published online by Cambridge University Press:  01 January 2021

Sadath A. Sayeed
Get access Rights & Permissions [Opens in a new window]

Extract

In the past few years, medical practices surrounding the decision to resuscitate marginally viable newborns have received a fair amount of attention. Baroness Warnock, of the UK Nuffield Council on Bioethics, has recently suggested that Britain follow the recommended practice in Holland of setting a gestational age limit below which marginally viable newborns should not be routinely resuscitated, despite reported statistical probabilities of raw survival approaching twenty percent. In the US, a highly publicized case from Texas came to a controversial legal conclusion, permitting physicians to disregard parental preference for palliative care and unilaterally initiate resuscitation when faced with the birth of an extremely premature baby.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 34 , Issue 3 , Fall 2006 , pp. 600 - 610
Copyright
Copyright © American Society of Law, Medicine and Ethics 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See e.g., Janvier, A. Barrington, K. J., “The Ethics of Neonatal Resuscitation at the Margins of Viability: Informed Consent and Outcomes,” Journal of Pediatrics 147 (2005): 579–85; and Lorenz, J. M., “Ethical Dilemmas in the Care of the most Premature Infants: The Waters are Murkier than Ever,” Current Opinions in Pediatrics 17, no. 2 (2005): 186–190.CrossRefGoogle Scholar
Boseley, S., “Should Doctors do all they can to Keep Very Premature Babies Alive?” Guardian Unlimited, June 9, 2005, accessible on-line at <http://www.guardian.co.uk/science/thisweek/story/0,1679792,00.html> (last visited April 18, 2006).+(last+visited+April+18,+2006).>Google Scholar
Miller v. HCA, Inc., 118 S.W.3d 758, 771 (Tex. 2003).Google Scholar
Higgins, R. D. Delivoria-Papadopoulos, M. Raju, T. N. K., “Executive Summary of the Workshop on the Border of Viability,” Pediatrics 115, no. 5 (2005): 1392–1396.CrossRefGoogle Scholar
See, e.g. Rhoden, N. K., “Treating Baby Doe: The Ethics of Uncertainty,” Hastings Center Report 16 (1986): 34–42; Weir, R. F., Selective Nontreatment of Handicapped Newborns: Moral Dilemmas in Neonatal Medicine (New York: Oxford University Press, 1984); Deciding to Forego Life-Sustaining Treatment: A Report on Ethical, Medical, and Legal Issues in Treatment Decisions (Washington, D.C.: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1983): 218–9.CrossRefGoogle Scholar
Annas, G. J., “Extremely Preterm Birth and Parental Authority to Refuse Treatment – The Case of Sidney Miller,” New Engl. J. of Med. 351, no. 20 (2004): 2118–2123.CrossRefGoogle Scholar
H. MacDonald and the Committee on the Fetus and Newborn, “Perinatal Care at the Threshold of Viability,” Pediatrics 110, no. 5 (2002): 1024–1027.CrossRefGoogle Scholar
Contributors and Reviewers for the Neonatal Resuscitation Guidelines, “International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science,” Pediatrics 106, no. 3 (2000), available at <http://www.pediatrics.org/cgi/content/full/106/3/e29> (last visited April 18, 2006).+(last+visited+April+18,+2006).>Google Scholar
Wall, S. N. Partridge, J. C., “Death in the Intensive Care Nursery: Physician Practice of Withdrawing and Withholding Life Support,” Pediatrics 99 (1997): 64–70.CrossRefGoogle Scholar
Born-Alive Infants Protection Act of 2001, Report together with additional and dissenting views of the House Committee on the Judiciary, 107th Cong, 1st Sess (August 2, 2001): 1–38, at 3. (Purpose and Summary).Google Scholar
Pub L. No. 107-207, 116 Stat 926 (2002).CrossRefGoogle Scholar
Sayeed, S. A., “‘Baby Doe Redux?’ The Department of Health and Human Services and the Born-Alive Infants Protection Act of 2002: A Cautionary Note on Normative Neonatal Practice,” Pediatrics 116 no. 4 (2005), available at <www.pediatrics.org/cgi/content/full/116/4/e576-e585> (requires subscription – link through <www.pediatrics.org/cgi/content/full/116/4>) (last visited April 18, 2006).CrossRefGoogle Scholar
Boyle, D. Carlo, W. A. Goldsmith, J. et al., and the American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee, Born-Alive Infants Protection Act of 2001, Public Law No. 107-207; Pediatrics 111, no. 3 (2003): 680–6811.CrossRefGoogle ScholarPubMed
42 U.S.C. § 1395dd (1994).Google Scholar
Center for Medicaid and State Operations/Survey and Certification Group, Interaction of the Emergency Medical Treatment and Labor Act (EMTALA) and the Born-Alive Infants Protection Act of 2002, Baltimore, MD, US Dept of Health and Human Services, Centers for Medicare and Medicaid Services; April 22, 2005. Ref: S&C-05-26.Google Scholar
42 CFR 489.24 (10/1/04 Ed.)Google Scholar
MacFarlane, P. I. Wood, S. Bennett, J., “Non-Viable Delivery at 20–23 Weeks Gestation: Observations and Signs of Life after Birth,” Archives of Disease in Childhood – Fetal and Neonatal Edition 88 (2003): 199–202.CrossRefGoogle Scholar
Partridge, J. C. Freeman, H. Weiss, E. Martinez, A. M., “Delivery Room Resuscitation Decisions for Extremely Low Birthweight Infants in California,” Journal of Perinatology 21 (2001): 27–33.CrossRefGoogle Scholar
Born-Alive Infants Protection Act of 2001, Report Together with Additional and Dissenting Views of the House Committee on the Judiciary, 107th Congress, 1st Session (2001), August 2, 2001: 1–38.Google Scholar
See Montalvo v. Borkovec, 647 N.W.2d 413 (Wis.App. 2002), and Miller v. HCA, Inc., 118 S.W.3d 758, 771 (Tex. 2003).Google Scholar
Cf., Lopez-Soto v. Hawayek, 175 F.3d 170 (1st Cir. 1999).Google Scholar
Preston v. Meriter Hosp., 2005 WI 122.Google Scholar
Burks v. St. Joseph's Hospital, 223 Wis. 2d 265, 588 N.W.2d 927, 929 (1999).Google Scholar
Hurst, I., “Baby Doe Rules [letter],” Pediatrics 116 (2005): 1600–1602.CrossRefGoogle Scholar
Miller v. HCA, Inc., 118 S.W.3d 758 (Tex. 2003).Google Scholar
Nondiscrimination on the basis of Handicap; Procedures and Guidelines Relating to Health Care for Handicapped Infants – HHS, Final Rules, Federal Register 50 (1985): 14879–14892.Google Scholar
McCullough, L. B., “Neonatal Ethics at the Limits of Viability,” Pediatrics 116 (2005): 1019–1021.CrossRefGoogle Scholar
Helft, P. R. Siegler, M., and Lantos, J., “The Rise and Fall of the Futility Movement,” N. Engl. J. Med. 343 (2000): 293–296.CrossRefGoogle Scholar
Fine, R. L. Whitfield, J. M. Carr, B. L., and Mayo, T. W., “Medical Futility in the Neonatal Intensive Care Unit: Hope for a Resolution,” Pediatrics 116 (2005): 1219–1222CrossRefGoogle Scholar
Lorenz, J. M., Seminars in Neonatology 8 (2003): 475–482; Lucey, J. F. Rowan, C. A. Shiono, P. et al., “Fetal Infants: The Fate of 4172 Infants with Birth Weights of 401 to 500 Grams – The Vermont Oxford Network Experience (1996–2000),” Pediatrics 113 (2004): 1559–1565CrossRefGoogle Scholar
Paris, J. J. Schreiber, M. D., and Reardon, F., “Ethical and Legal Issues,” in Assisted Ventilation of the Newborn, 4th edition, Goldsmith, J. P. and Karotkin, E. H., eds. (New York: Saunders, 2003): 81.CrossRefGoogle Scholar
Kopelman, L. M., “Baby Doe Rules,” [letter] Pediatrics 116 (2005); 514–515.CrossRefGoogle Scholar
Frader, J. E., “Baby Doe Rules,” [letter] Pediatrics 116 (2005): 1601–1602.CrossRefGoogle Scholar
Buchanan, A., “Medical Paternalism,” Philosophy and Public Affairs 7, no. 4 (1978): 78–109.Google Scholar
Arras, J., “Toward an Ethic of Ambiguity,” Hastings Center Report 4 (1985): 25–33.Google Scholar
In re Christopher I. (2003) 106 Cal.App.4th 533.Google Scholar
Montalvo v. Borkovec, 647 N.W.2d 413 (Wis.App. 2002).Google Scholar
Robertson, J. A., “Involuntary Euthanasia of Defective Newborns: A Legal Analysis,” Stanford Law Review 27 (1975): 213–254.CrossRefGoogle Scholar
Gillett, G., “Reasoning in Bioethics,” Bioethics 17, no. 3 (2003): 243–260.CrossRefGoogle Scholar
Streiner, D. L. Saigal, S. Burrows, E. Stoskopf, B. and Rosenbaum, P., “Attitudes of Parents and Health Care Professionals Toward Active Treatment of Extremely Premature Infants,” Pediatrics 108 (2001): 152–157.CrossRefGoogle Scholar
Kaempf, J. W. et al., “Medical Guidelines for Periviability Counseling,” Pediatrics 117 (2006): 22–29.CrossRefGoogle Scholar
Calabresi, G., “Reflections on Medical Experimentation in Humans,” Daedalus 98 (1969): 387–393.Google Scholar
Cowley, C., “A New Rejection of Moral Expertise,” Medicine, Health Care, and Philosophy 8 (2005): 273–279.CrossRefGoogle Scholar