Abstract
BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0152-y) contains supplementary material, which is available to authorized users.
Highlights
Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost
Guidelines relating to provision of intensive care for critically ill newborns have traditionally focused on the best interests of infants [4]
There are limited resources available within neonatal intensive care units (NICU) [5], meaning that sometimes treatment that would be in the best interests of an infant is not available
Summary
Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. There are, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. Advances in medical technology enable doctors to save the lives of newborn infants who would have previously died [1, 2] Some of these infants have a low chance of survival with treatment, or may survive with significant morbidity and shortened life expectancy [3]. Guidelines relating to provision of intensive care for critically ill newborns have traditionally focused on the best interests of infants [4]. There are limited resources (including staff, equipment and physical space) available within neonatal intensive care units (NICU) [5], meaning that sometimes treatment that would be in the best interests of an infant is not available. How should doctors allocate limited resources and decide which patients to treat?
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