Treating Baby Doe: the ethics of uncertainty

Abstract

The ethical tensions inherent in all Baby Doe treatment decisions are compounded by medical uncertainty. Physicians both here and abroad have adopted various strategies. Swedish doctors tend to withhold treatment from the beginning from infants for whom statistical data suggest a grim prognosis. The British are more likely to initiate treatment but withdraw it if the infant appears likely to die or suffer severe brain damage. The trend in the U.S. is to start treating any baby who is potentially viable and continue until it is virtually certain that the infant will die. The "least worst" strategy is an individualized one: starting treatment, gathering data, and then reassessing the decision.

KIE: Rhoden's research has revealed that physicians in the U.S., Great Britain, and Sweden employ different decision making strategies when treating severely impaired newborns whose medical prognosis is uncertain. Swedish physicians tend to withhold treatment when statistical data suggest a grim prognosis. The British tend to initiate treatment but withdraw it when death or severe brain damage appears likely. In the U.S., the tendency is to treat all potentially viable newborns until death appears virtually certain. The author analyzes these strategies and concludes that the "least worst one" is an individualized prognostic approach: initiating treatment, gathering data, and then reassessing the decision. This approach is most consistent with sensitivity to the parents' role and is unconstrained by overly simplistic vitalism, excessive fear of legal liability, or an ethically untenable distinction between withholding and withdrawing treatment.