Evidence-based ethics and the care of premature infants

Abstract

Despite the success of newborn intensive care, a vexing ethical question remains: Which preterm infants are so malformed, sick or immature that newborn intensive care should not be administered? In an attempt to answer this question, this article examines current clinical practices and the persisting effects of the controversial Baby Doe regulations. The scientific evidence for current practices is critically analyzed in relation to fundamental ethical issues for marginally viable patients of any age. A variety of strategies--some highly provocative--is proposed and discussed to facilitate better-informed, better-justified, more broadly acceptable, and more fiscally responsible ethical decisions in the care of preterm infants.