Ethical issues and dilemmas in the care of newborn babies in the developing world

Abstract

Ethical issues in critically sick newborn babies are often governed by economic and social realities, gender of the child, an attitude of ‘paternalism’ by paediatricians and in developing countries a fatalistic attitude of surrender to the will of God. Ethical decisions in perinatal medicine are difficult and often complicated by profound medical uncertainty for making a correct diagnosis and prognosis of maternal, fetal and neonatal conditions. It is a sad reality that even essential newborn care is not available to a large number of salvageable babies in the developing world. By contrast, in several developed countries, parents exhibit unbridled autonomy and may demand everything conceivable even for extremely tiny babies or non-salvageable infants having lethal congenital malformations. Correct ethical decisions are based on sound medical facts and should be taken jointly by all the medical and nursing carers, and by taking the family into confidence. To ensure justice and cost-effectiveness, the narrow principle of ‘best interest’ of the child should be replaced by a concept of global beneficence to the family, society and the State. Ethical issues in critically sick newborn babies are often governed by economic and social realities, gender of the child, an attitude of ‘paternalism’ by paediatricians and in developing countries a fatalistic attitude of surrender to the will of God. Ethical decisions in perinatal medicine are difficult and often complicated by profound medical uncertainty for making a correct diagnosis and prognosis of maternal, fetal and neonatal conditions. It is a sad reality that even essential newborn care is not available to a large number of salvageable babies in the developing world. By contrast, in several developed countries, parents exhibit unbridled autonomy and may demand everything conceivable even for extremely tiny babies or non-salvageable infants having lethal congenital malformations. Correct ethical decisions are based on sound medical facts and should be taken jointly by all the medical and nursing carers, and by taking the family into confidence. To ensure justice and cost-effectiveness, the narrow principle of ‘best interest’ of the child should be replaced by a concept of global beneficence to the family, society and the State.