Ethical problems in the care of high risk neonates.

Recent progress in neonatal care has greatly improved the prognosis and the probabilities of survival in very sick or very preterm neonates and has modified the concept and limits of the so called viability. However, in some circumstances, when the death of the baby can only be postponed temporarily, at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and the family, then it might not be appropriate to utilize all the armamentarium of neonatal intensive care. In such circumstances, limitation of intensive treatments (withholding or withdrawal) generally invasive and painful, could represent a more human and reasonable alternative. The ethical principles underlying those decisions, the most frequent situations occurring in practice, the role of parents in the decision-making process, and the opinions and behavior of neonatologists from many European intensive care units will be examined and discussed.