There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant’s deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably (...) healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions. (shrink)

A common utilitarian argument in favor of abortion for fetal defects rests on some controversial assumptions about what counts as a life worth living. Yet critics of abortion for fetal defects are also in need of an argument free from controversial assumptions about the future child's quality of life. Christopher Kaczor (in: Kaczor (ed), The ethics of abortion: women's rights, human life, and the question of justice, Routledge, New York, 2011) has devised an analogy that apparently satisfies this condition. On (...) close scrutiny, however, Kaczor's analogy is too weak to debunk the common-morality intuition that at least some abortions for fetal defects are morally permissible. The upshot of this discussion is that, on the moral permissibility of abortions for fetal defects, a case-by-case approach is to be preferred. (shrink)

OBJECTIVES: To study attitudes in the Danish population towards treatment of severely handicapped and extremely preterm infants and to define areas of consensus and controversy. DESIGN: Mail-delivered questionnaire. SETTING: Denmark. Survey sample--A random sample of 1080 persons aged from 18 to 45 years. RESULTS: The overall response rate was 68%. There was strong consensus (more than 75% agreement) that life-prolonging treatment should be provided for an infant born after 24 weeks' gestation with respiratory distress and, for an infant with myelomeningocele, (...) when the parents were in favour of treatment. Further, there was almost uniform agreement that not all infants should be treated no matter how serious the condition. Major controversies concerned the severity of a condition needed to justify omission of life-prolonging treatment, the role of parental attitude and the options in non-treatment cases. Forty-six per cent thought it ought to be legal to kill the infant in at least some of these cases. CONCLUSION: Although the study revealed wide divergences of opinion with regard to questions about limits of treatment and about end-of-life decisions it also showed that there was general acceptance both that life-prolonging treatment ought to be provided even in relatively severe cases if this was in accordance with parental wishes, and that life should not be saved at all costs. (shrink)