Decision-making in Neonatal Intensive Care

Abstract

This review traces the history of judicial and legislative interventions into proxy decision-making by parents and physicians on behalf of neonates in intensive care units. The doctrine of parens patriae is traced from the first governmental intrusions into life-support decisions for newborns who had congenital anomalies during the 1980s to the 2002 federal legislation on the legal status of “born-alive” infants. Ethical problems inherent in decisions to resuscitate and provide neonatal intensive care for extremely preterm infants are discussed. A formal shared decision-making approach to care in the neonatal intensive care unit (NICU) could limit the need for legal or legislative intrusions into the complex decisions about the appropriateness of care for infants born at the margin of viability.