Neonatal Ethics at the Limits of Viability

Abstract

In this month's Pediatrics electronic pages , Dr Sayeed1 does the neonatology community an important service by calling our attention to the Born-Alive Infants Protection Act of 2002 and its implications for the clinical standards and ethics of neonatal practice. This new federal legislation goes beyond the Baby Doe rule from 1984,2,3 which technically required reporting of cases in which infants were allowed to die without one of the stipulated exceptions applying. As Sayeed reports, the Born-Alive Infants Protection Act has been interpreted by the Secretary of the US Department of Health and Human Services to mean that the department “will investigate all circumstances where individuals and entities are reported to be withholding medical care from an infant born alive in potential violation of federal statutes for which we are responsible.”1 The strategy seems to be to continue that envisaged (but never really enforced) under the Baby Doe rule: to respond to reports rather than seek to directly regulate the practice of neonatology, a regulatory function traditionally left to the states in our federal system of self-government. Sayeed's summary of the law's potential effect invokes a vivid and apt metaphor: “the current administration's resurrection of recently quiescent oversight of the treatment of imperiled newborns agitates the legal fault line that physicians walk along when caring for these infants.”1 Sayeed raises a number of serious ethical concerns about this new law, and he should be saluted for doing so. Sayeed is entirely correct to point out that the law may be more substantive and serious in its effect on clinical practice in neonatology than the American Academy of Pediatrics seems to think, based on the opinion that Sayeed quotes. I will address some of the major concerns that he has identified. Sayeed reads the new … Address correspondence to Laurence B. McCullough, PhD, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail: mccullou{at}bcm.tmc.edu