The legal landscape at the threshold of viability for extremely premature infants: a nursing perspective, part I.

One of the most difficult decisions that can confront a family is what medical treatment to seek for an extremely premature infant at the threshold of viability. The complexity of the treatment options, competing interests of healthcare providers and the family, consideration of the parents' values, and the sheer immensity of making decisions that affect such a new and fragile life all converge on parents when making such decisions. Overlying this are the legal context and the healthcare professionals and institutions that often may have more direct control and impact on those decisions than the parents. In the United States, the law since the so-called baby doe regulations has not provided much in the way of consistent guidance. Federal attempts to micromanage the decision-making process and draw bright lines have largely failed. Conflicts between the competing interests sometimes end up in court, and the law is developing state by state with widely varying results. Parental consent to treatment of their infants is at the crux of these conflicts. Part I of this article discusses the evolving legal landscape of decision making for treatment of infants at the threshold of viability. Part II will address informed consent and the fundamental role nurses can play in creating a collaborative decision-making process that respects the best interests of the infant and the family.