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In the NICU, technology most clearly drives ethics. Twenty years ago, we simply couldn’t save (or had a very difficult time saving) 25 week old infants. There was no dilemma as to whether we should save them. We simply couldn’t. Now, we have the technology, but we also have new ethical choices before us. In discussion this week, my questions ask you to focus on who should decide whether a very premature infant lives or dies. “Who decides” reflects other ethical questions as well. I have heard pediatric specialists talk to their medical assistants about whether it is right to do everything possible to save a child without consideration of whether the parents can care for the child later, especially if he or she will be extremely disabled. This is a good question, and there are more questions to ask too. Your assigned reading this week takes a particular point of view on this topic, but I appreciate that he also gives a little historical context to the issues. The Wicclair essay sets futility in a larger clinical context. Is it ever right for a medical professional to refuse to provide an intervention for a patient on the grounds of futility? These are issues hospitals in the U.S. struggle with nearly every week.
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