Perinatal And Neonatal Ethics

Neonatal intensive care has been one of the most morally controversial areas of medicine during the last thirty years. This study offers an expansive view of the abstract and practical features of neonatal medicine, examining the interconnected development of four key aspects of neonatal intensive care: medical advances, ethical analysis, legal scrutiny, and econometric evaluation. Tracing the recent history of neonatal ethics, analyzing the notable advances, and considering the many lessons to be learned, the authors present neonatal medicine as a paradigm of responsible societal management of medical innovation.

Advances in reproductive and perinatal medicine have given rise to difficult ethical issues. Do all women have the right to choose whether to reproduce? What is the moral status of the fetus during various stages of gestation and what obligations do parents have to the fetus during this period? In this book Carson Strong develops an ethical framework that helps resolve these and many other issues of vital concern to health professionals, policymakers, and the general public. Strong begins by exploring the significance of reproductive freedom, drawing on constitutional law and feminist writings, among other sources. Next he assesses the moral status of offspring during preembryonic, embryonic, fetal, and postnatal stages of development, discussing the obligations of procreators during gestation and offering a new perspective on the idea that the moral standing of the fetus increases as fetal development proceeds. He then suggests an approach to the question of how priorities should be assigned to conflicting values, one that draws on a version of casuistic reasoning. In the second half of the book, Strong applies this ethical framework to some of the problematic areas in reproductive and perinatal medicine. These include prenatal genetic testing for susceptibilities to common diseases and for "enhancement" of offspring; research using preembryos and embryos; nontraditional family arrangements, such as surrogate motherhood and ovum donation for older women; and treatment of fetuses with anomalies. His discussion takes into account the clinical dimensions of issues and reflects a thorough consideration of the ethical, legal, medical, and psychosocial literature.

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.

From the time of conception, through the gestation of pregnancy, to the birth of a newborn child exists an extraordinary, emergent ethics. How does this ethics come into being when a child is conceived? How does the appearance of ethics in pregnancy differ from its emergence after birth? How does the original meaning of ethics relate to modern morality in decision making? In this book, Michael van Manen explores these ethical moral complexities and conceptualizations of life’s beginnings. He delves into perennial and contemporary aspects of conception, pregnancy, and birth to present ethics as a fundamental phenomenon in the experiential encounter between parent and child. Even in the context of neonatal-perinatal medicine, where all manner of medical technologies and illnesses may potentially complicate the developing relation of parent and child, ethics is always already present yet also enigmatic in its origin. And yet, to approach ethical moral questions, we need to understand the inception of ethics. The Birth of Ethics: Phenomenological Reflections on Life’s Beginnings is an essential text not only for health professionals and researchers but also for parents, family members, and others who care and take responsibility for newborns in need of medical care.

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.

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?