Premature and Compromised Neonates

This chapter explores health care resource allocation issues and ethical problems related to premature and compromised neonates. Neonatal intensive care is expensive, and decisions about treatment provision or limitation respond to many considerations: family's desires, urgency, need, cost containment. Because there is a higher incidence of prematurity among the urban poor, particularly among the urban African-American poor, any limitation on treatment for seriously compromised neonates would fall disproportionately on that population. This chapter considers three different kinds of challenges in neonatology: the lower limits of viability, discontinuing intensive care support for a neonate, and the problems associated with infants having congenital anomalies. It argues that U.S. laws mandating life-saving treatment for infants regardless of their risk of disability conflict with the best-interest standard and with consideration for family desires as well as the burdens imposed by a disabled child. Finally, it emphasizes the need for physicians to engage families in full and open discussions of each child's possible future uncolored by medical biases.