Neonatal intensive care has been one of the most morally controversial areas of medicine during the past thirty years. This study examines the interconnected development of four key aspects of neonatal intensive care: medical advances, ethical analysis, legal scrutiny, and econometric evaluation. The authors assert that a dramatic shift in societal attitudes toward newborns and their medical care was a stimulus for and then a result of developments in the medical care of newborns. They divide their analysis into three eras of neonatal intensive care. The first, characterized by the rapid advance of medical technology from the late 1960s to the Baby Doe case of 1982, established neonatal care as a legitimate specialty of medical care, separate from the rest of pediatrics and medicine. During this era, legal scholars and moral philosophers debated the relative importance of parental autonomy, clinical prognosis, and children's rights. The second era, beginning with the Baby Doe case (a legal battle that spurred legislation mandating that infants with debilitating birth defects be treated unless the attending physician deems efforts to prolong life "futile"), stimulated efforts to establish a consistent federal standard on neonatal care decisions and raised important moral questions concerning the meaning of "futility" and of "inhumane" treatment. In the third era, a consistent set of decision-making criteria and policies was established. These policies were the result of the synergy and harmonization of newly agreed upon ethical principles and newly discovered epidemiological characteristics of neonatal care. Tracing the field's recent history, notable advances, and considerable challenges yet to be faced, the authors present neonatal bioethics as a paradigm of complex conversation among physicians, philosophers, policy makers, judges, and legislators which has led to responsible societal oversight of a controversial medical innovation.

The rapid development of new technology used in obstetrics and neonatology has been accompanied by new moral problems presented by the choices this technology generates. Ethics and Perinatology is a timely examination of the moral problems caused by clinical and research practices in perinatology. 14 major issues are each addressed by a leading clinician whose writing is then critically reviewed by a medical ethicist, a legal theorist, or an economist. Thus each chapter embodies the independent perspectives of international experts from different disciplines. This book offers a new approach to the presentation of ideas in medical ethics concerning obstetrics and perinatology that will benefit all physicians, nurses, philosophers, and medical ethicists, as well as the interested lay reader.

This volume provides a practical overview of the ethical issues arising in pediatric practice. The case-based approach grounds the bioethical concepts in real-life situations, covering a broad range of important and controversial topics, including informed consent, confidentiality, truthfulness and fidelity, ethical issues relating to perinatology and neonatology, end-of-life issues, new technologies, and problems of justice and public health in pediatrics. A dedicated section also addresses the topics of professionalism, including boundary issues, conflicts of interests and relationships with industry, ethical issues arising during training, and dealing with the impaired or unethical colleague. Each chapter contains a summary of the key issues covered and recommendations for approaching similar situations in other contexts. Clinical Ethics in Pediatrics: A Case-Based Textbook is an essential resource for all physicians who care for children, as well as medical educators, residents and scholars in clinical bioethics.

Most neonates who now survive intensive care would have died 50 years ago, and “nature” would have decided the outcomes, making ethical discussions about initiating or withholding resuscitation irrelevant. Medical developments in neonatology have changed the way we respond to diseases of neonates, to their illness, and to their parents. Not only as physicians, but also as a society. Decisions on when to start, withhold, or withdraw life-saving interventions in critically ill neonates are among the most difficult decisions in pediatric practice. These decisions are fraught with ethical dilemmas, for example deciding whether withholding intensive care –leading to death- is superior to uncertain survival with a risk of disability and the additional burden of intensive care. This book covers important ethical questions that arise in neonatal intensive care units. Questions such as, whether to intervene medically and whether we are good at predicting the outcome of fragile neonates; whether a medical intervention should be withheld or withdrawn, and who should be primarily responsible for these decisions and how?

Each year, neonatal Intensive care units (NICUs) in the U.S. and around the world help thousands of sick or premature newborns survive. NICUs are committed to the ideals of family-centered care, which encourages shared decision-making between parents and NICU caregivers. In cases of infants with conditions marked by high mortality, morbidity, or great suffering, family-centered care affirms the right of parents to assist in making decisions regarding aggressive treatment for their infant. Often, these parents' difficult and intimate decisions are shaped profoundly by their religious beliefs. In light of this, what precisely are the teachings of the major world religious traditions about the status and care of the premature or sick newborn? Few studies have grappled with what major religious traditions teach about the care of the newborn or how these teachings may bear on parents' decisions. This volume seeks to fill this gap, providing information on religious teachings about the newborn to the multidisciplinary teams of NICU professionals (neonatologists, advance practice nurses, social workers), as well as to parents of NICU patients, and students of bioethics. In chapters dealing with Judaism, Catholicism, Denominational Protestantism, Evangelical Protestantism, African American Protestantism, Sunni and Shi'a Islam, Hinduism, Buddhism, Navajo religion, and Seventh Day Adventism, leading scholars develop the teachings of these traditions on the status, treatment, and ritual accompaniments of care of the premature or sick newborn. This is an essential book that will serve as a first resort for clinicians who need to understand the religious dynamics influencing anyone making a difficult decision about her sick newborn.

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.

This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.