Living on the Front Line: Ethical Issues in the Care of Extremely Premature Newborns in Israel

Abstract

The advancement in neonatal medicine in the past several decades is characterized, among other parameters, by the increasing provision of intensive care to preterm newborns. Understanding the ethical issues arising throughout the provision of intensive care for extremely premature newborns in different gestational ages is an essential step in the process of developing recommendations or guidelines on a national level, regarding the care of those patients. In Israel, a relatively high birth rate, low infant mortality rate and a significant premature infant birth rate make policy-making in this area particularly challenging. In this paper we focus on ethical dilemmas and decision-making issues which the Israeli health care team encounters when dealing with the desired approach to the care of premature infants at the border of viability. We start by a brief description of the current situation in Israel in regard of birth and prematurity. We then move on to discuss the legal, moral and social status of the fetus and newborn in Israel. The heart of this paper is a review of the existing guidelines and statutes regarding the care for extremely premature newborns in Israel and the ethical and decision- making issues it brings into the table. Keywords: Extreme prematurity, ethics, health care practices, resuscitation, end-of-life decisions