Weir Mark, Evans Marilyn, Coughlin Kevin
Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London ON.
School of Nursing, Faculty of Health Sciences, University of Western Ontario, London ON.
J Obstet Gynaecol Can. 2011 Jan;33(1):49-56. doi: 10.1016/S1701-2163(16)34773-9.
Across Canada, the rate of preterm birth (i.e., at < 37 weeks' gestation) has been steadily increasing. Advances in perinatal medicine and neonatal intensive care have resulted in an increased capacity to intervene at the extremes of prematurity, leading to an increase in the overall survival of infants born at early gestations. There has been little corresponding decrease in long-term complications. As a result, additional stresses are placed on neonatal intensive care units across the country, impacting families, health care professionals, and society as a whole. Moral distress and moral residue are often cited in the neonatal-perinatal literature as stressors experienced by those who participate in the resuscitation decision-making process. They are directly related to the challenge of making a concrete decision about life and death at extremely early gestations in the context of long-term uncertainty. In this review, we performed a systematic search of medical and ethics literature pertaining to resuscitation at the extremes of prematurity. The perspective of health care professionals is explored, including how definitions of viability and parental perspectives contribute to the decision-making process. We argue for the necessity of further research exploring the inter-professional context of ethical decision making at the extremes of prematurity.
在加拿大全国范围内，早产率（即妊娠<37周）一直在稳步上升。围产期医学和新生儿重症监护的进步使得在极早早产情况下进行干预的能力有所提高，从而导致早期妊娠出生婴儿的总体存活率上升。长期并发症却几乎没有相应减少。结果，全国各地的新生儿重症监护病房面临额外压力，影响到家庭、医疗保健专业人员以及整个社会。在新生儿围产期文献中，道德困扰和道德残留常被提及，是参与复苏决策过程的人员所经历的压力源。它们直接关系到在长期不确定性背景下，在极早早产阶段做出关于生死的具体决策所面临的挑战。在本综述中，我们对与极早早产复苏相关的医学和伦理学文献进行了系统检索。探讨了医疗保健专业人员的观点，包括生存能力的定义以及父母的观点如何影响决策过程。我们主张有必要进一步开展研究，探索极早早产情况下伦理决策的跨专业背景。
