Limiting treatment for extremely premature, low-birth-weight infants (500 to 750 g)
E. W. Young and D. K. Stevenson
Department of Health Policy Research, University School of Medicine, Stanford, CA 94305.
Despite impressive recent advances in neonatology, outcomes for extremely
premature, very-low-birth-weight infants (500 to 750 g) remain uneven. In a
situation of inherent uncertainty, treating patients vigorously could do
violence to the moral principles of nonmaleficence and (distributive)
justice. Equally, failing to treat patients vigorously because of concerns
about nonmaleficence and (distributive) justice could violate the principle
of patient-centered beneficence. Compounding this dilemma is the legacy of
the "Baby Doe Regulations." International perspectives on this particular
quandary are provided. We assert that at Stanford (Calif) University the
"individualized prognostic strategy" rather than the "wait until certainty"
approach prevails. Four concluding questions are posed: Why is prevention
not encouraged more than after-the-fact heroic intervention? Is it possible
to develop a more rational view of stopping aggressive therapy once having
started? Can we ignore the finitude of our medical resources? Is there a
need to redefine the nature of autonomy?
