La réanimation néonatale donne lieu à une demande publique et institutionnelle d'élaboration de normes, appelée par les dilemmes éthiques, induits par la pratique d'arrêt de vie ou de non réanimation. Ces dilemmes sont pratiquement levés par une référence aux « grands principes » qui régissent généralement la pratique médicale (dignité humaine, droit à la vie, droit à l'autonomie, obligation de soins, principe de non nuisance) ainsi que par l'exigence de suivre, pour procéder aux arrêts de vie, une « démarche transparente (...) et progressive », incluant une dimension délibérative. Dans la mesure où, en dépit de ces conditions, des désaccords éthiques légitimes demeurent et s'avèrent à l'analyse insolubles, il paraît nécessaire d'institutionnaliser ces désaccords afin de permettre aux personnes de « vivre ensemble » et de « travailler ensemble », en dépit de leurs divergences éthiques, toutes fondées sur de « bonnes raisons » morales. (shrink)

The Dutch rules governing neonatal euthanasia, known as the Groningen Protocol, require parental consent for severely disabled infants with poor prognoses to have their lives terminated. This paper questions whether parental consent should be dispositive in such cases, and argues that the potential suffering of the neonate or pediatric patient should be the decisive factor under such unfortunate circumstances.

Despite tremendous advances in medical care for critically ill newborn infants, caregivers in neonatal intensive care units still struggle with how to approach those patients whose prognoses appear to be the most grim, and whose treatments appear to be the most futile. Although the practice of passive neonatal euthanasia, from a moral perspective, has been widely condoned, those clinicians and families involved in such cases may still be found legally guilty of child abuse or even manslaughter. Passive neonatal euthanasia remains (...) both a moral dilemma and a legal ambiguity. Even the definition of passive euthanasia remains unclear. This manuscript reviews the basic moral and legal considerations raised by the current practice of neonatal euthanasia, and examines the formal position statements of the American Medical Association and the American Academy of Pediatrics. The paper concludes by emphasising the need, at least in the United States, to clarify the legal status of this relatively common medical practice. (shrink)

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, whilst (...) many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. (shrink)