Moral and Ethical Dilemmas in the Special-Care Nursery

Abstract Of 299 consecutive deaths occurring in a special-care nursery, 43 (14 per cent) were related to withholding treatment. In this group were 15 with multiple anomalies, eight with trisomy, eight with cardiopulmonary disease, seven with meningomyelocele, three with other Central-nervous-system disorders, and two with short-bowel syndrome. After careful consideration of each of these 43 infants, parents and physicians in a group decision concluded that prognosis for meaningful life was extremely poor or hopeless, and therefore rejected further treatment. The awesome finality of these decisions, combined with a potential for error in prognosis, made the choice agonizing for families and health professionals. Nevertheless, the issue has to be faced, for not to decide is an arbitrary and potentially devastating decision of default. (N Engl J Med 289:890–894, 1973)