Éthique et médecine périnatale : deux étapes de la réflexion professionnelle française, 2001-2008

Abstract

Constant advances in perinatal medicine in industrialized countries have raised challenging ethical dilemmas. This review addresses the evolution over the years 2000 of the recommendations on ethical issues in the perinatal period by health professionals in France. The Committee on Ethics of the French National Federation of Neonatologists issued one first set of recommendations in 2001. Additional information provided by nation-wide epidemiological studies on the long term development of premature infants, and the recent evolution of French law prompted the french societies of Neonatology, of Perinatal Medicine, and the National board of Obstetricians and Gynaecologists to set new guidelines concerning the end of life in the neonatal period and euthanasia, neonatal palliative care, parental information, and issues related to the limits of viability, which are currently being published. These recent guidelines are characterized with attitudes favouring palliative care and discouraging active ending of life on neonates in situations with extremely poor neuro-cognitive prognosis. Around the limits of viability, a grey zone is defined over the 24-25 weeks gestational age period, during which various options are discussed, in compliance with the basic principle of the preservation of the individual rights of each infant.