Anemia of Prematurity - Portal Neonatal

Ethical Issues in Neonatal Care
Last Updated: November 2, 2003
Synonyms and related keywords: clinical ethics, bioethics, medical ethics, healthcare ethics
AUTHOR INFORMATION Section 1 of 8
Author: Brian S Carter, MD, Associate Director, Associate Professor, Department of Pediatrics,
Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical Center
Brian S Carter, MD, is a member of the following medical societies: American Academy of
Pediatrics, American Society for Bioethics and Humanities, National Perinatal Association, and
Southern Society for Pediatric Research
Editor(s): Scott MacGilvray, MD, Associate Professor, Department of Pediatrics, Pitt County
Memorial Hospital; Robert Konop, PharmD, Director, Clinical Account Management, Ancillary
Care Management; Brian S Carter, MD, Associate Director, Associate Professor, Department of
Pediatrics, Division of Neonatology, Vanderbilt University Medical Center and Gateway Medical
Center; Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of
Neonatology, Medical University of South Carolina; and Neil N Finer, MD, Director, Division of
Neonatology, Professor, Department of Pediatrics, University of California at San Diego
Background
INTRODUCTION Section 2 of 8
As neonatal medicine has developed in the United States, clinical ethics (ie, bioethics, medical
ethics, healthcare ethics) also have become increasingly present in the healthcare environment.
For more than 30 years, neonatal medicine has been practiced to provide specialized and intensive
care measures aimed at improving the health and survival of premature and critically ill newborns.
Throughout this period, great strides have been made in improving the technical capabilities that
allow more rapid and precise diagnoses, effective monitoring, and specific therapy. The availability
of special-care nursery beds has increased dramatically. The number of trained professionals and
specialists also has risen.
The results of these progresses are mixed. A substantial reduction in the mortality of premature
infants has occurred. Furthermore, the rate of handicap or significant morbidity appears to have
remained steady or declined in survivors of the neonatal intensive care unit (NICU) of nearly all
gestational ages and weights. Despite these facts, the rate of prematurity has not declined in the
United States, nor has the rate of low birth weights. Also, the rate of birth defects remains relatively
constant, and infant mortality, though diminished over the past decade, remains higher in the
United States than in many developed nations. Finally, the discrepancy between black and
Caucasian infant mortality remains a concern.
ETHICAL QUESTIONS Section 3 of 8
Questions about the current state of practice in neonatal medicine are as follows:
• "Who deserves access to prenatal and neonatal specialty care?"
• "Who pays for this care?"
• "How can this care be assured and equitably distributed?"
• "Are some babies too sick or too premature for newborn intensive care?"
• "Who decides whether an infant receives care?"
• "How are these decisions made?"