Yale University School of Medicine, New Haven, CT, USA.
Yale New Haven Children's Hospital, New Haven, CT, USA.
J Perinatol. 2021 Jan;41(1):173-178. doi: 10.1038/s41372-020-00841-6. Epub 2020 Sep 30.
Critical decision-making in neonatology and other areas of pediatrics often carries with it a complex and difficult ethical component. For any treatment under consideration, the impermissible-permissible-obligatory (I-P-O) spectrum provides a useful framework for determining how to proceed. Any proposed treatment can be located along this spectrum, and identified as either ethically impermissible, permissible, or obligatory. Treatments determined to be ethically impermissible should not be made available by physicians. Those deemed ethically permissible should be explained to parents, commonly with a specific recommendation. Informed parents should then be free to choose from among permissible options. Potential treatments deemed ethically obligatory should be provided to the patient, even in the face of parental objection. The fundamental ethical work in neonatology and pediatrics is determining where on the I-P-O spectrum a treatment under consideration should be located. This should be determined by the prognosis for the patient with and without the treatment, the feasibility of providing the treatment, and consideration of all relevant rights and obligations. Location on the line is dynamic, and clinicians should be open to movement of a given treatment along the spectrum as new information, particularly regarding effectiveness, toxicity, and/or alternatives, becomes available. This framework provides a structure for ethical conversation and decision-making related to a specific patient, as well as in the formation of institutional and national guidelines.
新生儿学和儿科学等领域的关键决策通常带有复杂且困难的伦理因素。对于任何考虑中的治疗，允许-禁止-义务（I-P-O）频谱为确定如何进行提供了一个有用的框架。任何拟议的治疗都可以沿着这个频谱定位，并确定为伦理上不允许、允许或义务。被认为在伦理上不允许的治疗不应由医生提供。那些被认为在伦理上允许的治疗应该向家长解释，通常伴有具体的建议。知情的家长应该可以在允许的选择中自由选择。被认为在伦理上义务的潜在治疗应该提供给患者，即使面对家长的反对。新生儿学和儿科学中的基本伦理工作是确定考虑中的治疗在 I-P-O 频谱上的位置。这应该根据治疗前后患者的预后、提供治疗的可行性以及对所有相关权利和义务的考虑来确定。位置是动态的，随着有关有效性、毒性和/或替代方案的新信息的出现，临床医生应该对特定治疗沿着该谱的移动持开放态度。该框架为与特定患者相关的伦理对话和决策提供了结构，也为机构和国家指南的制定提供了结构。
