tailieunhanh - Extreme Prematurity - Practices, Bioethics, And The Law Part 9

Tham khảo tài liệu 'extreme prematurity - practices, bioethics, and the law part 9', y tế - sức khoẻ, sức khỏe trẻ em phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | EPILOGUE TRUTH TRUST AND BOUNDARIES gestational ages or weights as sole determinants for care. In the busy confines of hospital practice and in particular intensive care there is a pressure to reduce the complexity of decisions and act on rules that offer resolution of a problem at hand. Thus an a priori limit for intervention might be attractive in that setting. No resuscitation say for less than 25 weeks or 24 weeks gestation or less than a certain birth weight. Ethically this is hard to justify if the status of a preterm infant is viewed as the same as an adult with respect to the receipt of medical treatment. This becomes more so when early specific individual prognosis may be uncertain. As Simeoni and colleagues wrote 403 There is. a difference between saying 1 that a limit in terms of gestational age should be set for intensive intervention in extremely preterm infants and 2 that every infant deserves a unique approach concerning the application of intensive care backed by the information available on collective outcomes at the various gestational ages and perinatal conditions. The difference lies in intention. Its denial would challenge by extension the ethical bases of decision making in other medical situations. Thus treatment decisions for extremely preterm infants should be made based on a combination of factors which are recognized and interpretated by physicians and decided on by parents. How much actual power parents may have will vary depending on the clinical situation the legal jurisdiction and the attitudes of the physicians. Orfali and Gordon posed the questions does a system that emphasizes parents autonomy enable them to cope better as some studies and the bioethical theoretical literature strongly suggest How do parents without decision making power deal with such situations 404 They examined decision making in 191 EPILOGUE TRUTH TRUST AND BOUNDARIES American and French neonatal intensive care units. The study was based on the assumption that