End-of-Life Decisions for Newborns
In Neonatal Bioethics: The Moral Challenges of Medical Innovation, John Lantos argues that neonatology should be viewed not as “one of the pinnacles of modern medical success, but instead as one of the best examples of modern medicine’s moral ambiguity or hubris” (Lantos and Meadow 2008: 4). On the one hand, its successes cannot be denied: Every year in neonatal intensive care units (NICUs) around the world, thousands of newborns are saved who, had they been born 50 years ago, would have died. On the other hand, the cost to these infants in what might be years of suffering, disability, or fragile health can sometimes be so high that it might have been better had they not been saved. Then too, there are moral puzzles that arise in the NICU that have nothing to do with end-of-life decisions. Given the moral ambivalence that characterizes all the decisions that must be made, ethics is an inseparable part of neonatology. In this chapter we focus on end-of-life decisions, examining many of the considerations that matter morally when they must be made, paying special attention to recent developments in The Netherlands. We’ll argue that the best ethical response to mortally ill newborns is to set treatment decisions into the context of palliative care.