Neonatal care: withholding or withdrawal of treatment in the newborn infant

Abstract

Life-sustaining treatment may be ethically withdrawn or withheld in critically ill or dying newborns if the action is genuinely in the best interests of the patient. This may occur in situations where life-sustaining treatment is futile because of a hopeless prognosis, or if the burdens of intensive treatment clearly outweigh its likely benefits. There is no fundamental ethical difference between the withholding of resuscitation and the withdrawing of life-sustaining treatment once it has commenced. However the actions may have different emotional and psychological implications. A decision to withdraw treatment should only be taken with the consensus of experienced staff caring for the baby and with the unpressurized agreement of the parents. Palliative care and symptomatic relief should always continue after life-support has been withdrawn. Emotional and practical support should be provided for parents and adequate training and support is essential for obstetric and neonatal unit staff.