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Neonates are babies within their first twenty-eight days of life. Neonatal intensive care often caters for babies in one of three groups – premature babies with low birth weight, full-term babies born with acute conditions or babies born with congenital anomalies.
Ethical issues mostly surround decision making on behalf of neonates. Decisions involve the weighing up of treatment that is beneficial or futile, considering the individual’s short-term and long-term prognosis. Two main issues in the decision making process are the chance of surviving medical intervention and future quality of life.
The most famous case of neonatal decision-making involved Baby Doe. In 1982, Baby Doe was born with Down’s syndrome and a tracheal-oesophageal fistula. The parents chose not to consent to the baby having the fistula repaired in surgery, based on the child’s best interests and lack of quality of life associated with Down’s syndrome. Baby Doe eventually died of starvation.
Treatment may be obligatory, optional or futile. It is often the case when the prognosis of a newborn looks good, that the parents and physicians agree to treat accordingly. However, occasionally parents do not want their newborn to be treated, and in these circumstances hospital ethicists are sometimes required to seek a court order to override the parent's decision and initiate treatment. It is more controversial when the prognosis of a neonate is unknown, and the parents with the physician are given the opportunity to discuss whether to treat or not. Bioethics addresses the parameters and obligations of those involved in the decision-making. Finally, there are cases when treatment is considered futile, yet the physician or the parents insist on treatment. Treatment in these situations is considered extremely burdensome and experimental and the chance of surviving treatment with any quality of life is small. Patient rights, parental rights and the duty of the physician are all considered in a bioethics evaluation.
Technology and medical interventions in the neonatal intensive care unit have developed at a steady pace over the past 40 years, and with this development there have been joyful stories of recovery but also saddening stories of severe disability. Bioethics can assist by addressing questions related to the regulation on use of experimental technological developments and by providing guidance in controversial situations.