15 November 2011
Neonatal Care: Playing God In The Nursery
Imagine never witnessing the magnificent golden sun rise or having the opportunity to hear the lulling angelic sounds of waves crashing along the sandy shore of the beach. Some people are born with defects that prevent them from enjoying the simplest things in life that many take for granted. The battle between what is morally correct and what is legally allowed in terms of limiting neonatal care for infants with severe congenital anomalies has raged for many years. A common parental instinct is to protect the child by all means necessary. Although in some cases, the question of how to protect children can be answered with the extremely vehement decision of allowing them to take their last breath in peace. Parents are generally mentally distraught as a result of these traumatic situations and often unfit to make serious decisions about the treatment of their child. In extreme situations for critically ill newborns, physicians should be allowed to make executive decisions in relation to the extent of treatment in the best interest of the child.
The background of ethical issues inside the Neonatal Intensive Care Unit is essential to understanding the current circumstances. There are many different laws regarding the process of decision making for terminally ill infants. The conflict was first brought to light in 1973. At this point in time, physicians were the primary decision makers for infants. Parents could merely make suggestions (Fleischman). Throughout advances in technology and medicine, the decisions became joint between the physicians and family. The progression of success in the Neonatal Intensive Care Unit has also allowed for the concept of “quality of life” to become a factor in the decision making process. The duty of mandating care for infants with the possibility of handicaps is given to the states (Fleischman). In addition to this, “federal regulations strongly urge the formation of infant care review committees,” also known as bioethics committees (Fleischman). Bioethics committees were installed for the purpose of reviewing cases involving ethical issues and to allow for more efficient communication between the medical community. As a result of the exponentially growing advancements, life saving became the paramount priority over ethics (“Neonatology”). This raises the questions, how much is too much care, and who is best fit to make these harsh decisions.
In 1982 the controversy of ethics and legal rights exploded over an infant born with harsh congenital defects in Indiana. The child’s abnormalities were surgically correctable, but he had only a fifty percent chance of survival (“The C. Everett Koop Papers”). It would have been a coup for a “Baby Doe” to live through the vigorous surgeries. The obstetrician who delivered “Baby Doe” informed the family that “even if surgeries were successful, their child would remain severely retarded and would face a lifetime of medical treatment, disability, and dependency” (“The C. Everett”). The majority of healthcare providers suggested withholding care, but the parents were left to make the decision. Ultimately agreed with the physicians, and opted to abstain from treatment (“The C. Everett”). The family’s decision was closely scrutinized. Attorneys attempted to label “Baby Doe” as a neglected child and expected the court to order mandatory treatment. The conclusion of the court was that the parents held the rights to make decisions for their child. The case was then appealed to the Supreme Court but before the case was heard “Baby Doe” died (“The C. Everett”). If the court had ruled against the family then care could have been forcibly administered to the child even against the parents will. A parent carelessly requesting no treatment for their child just because they are not “perfect” is unacceptable, although “Baby Doe’s” scenario should not be considered wrongful...
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