Norwegian University of Science and Technology.
St Olavs Hospital University Hospital in Trondheim.
Am J Bioeth. 2022 Nov;22(11):15-26. doi: 10.1080/15265161.2021.1925777. Epub 2021 May 17.
Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.
新生儿学的进步使得极早产儿的存活率提高。不成熟仍然存在短期和长期危害的高风险，而提供生命支持的不确定性将其变成了一个伦理困境。与父母共同决策已经取得了进展。然而，立即开始生命支持的必要性以及随之而来的停止治疗的困难，与公平决策过程的可能性之间存在紧张关系。父母的“拯救本能”和“拒绝撤回”都可能排除共同决策。为了帮助医疗保健人员并赋予父母权力，我们提出了一种标记为“延迟撤回”的新方法。在没有产前预先指示的情况下，在出生时开始提供生命支持，然后在一周后计划转向姑息治疗，除非父母在经过彻底的咨询过程后，积极要求继续提供生命支持。尽管存在情感挑战，但这种方法可以促进灰色地带中伦理平衡的决策过程。
