A time to be born and a time to die: ethical challenges in the neonatal intensive care unit.

摘要

To live or let die is an issue probably discussed more thoroughly in perinatal medicine than in most other fields of medicine. The ethical dimensions of periviabil-ity are huge for several reasons. First of all, the ability to survive has been steadily pushed to lower gestational ages. Second, it has been increasingly clear that many immature newborns survive with serious sequels.When in 1973 Duff and Campbell [1] for the first time described withholding and withdrawing of treatment of sick newborn babies, it included 14% of neonatal deaths. More recent studies have demonstrated that this now represents close to 90% of the deaths [2]. So what has happened during these 30-40 years? Could it be that doctors working with premature newborns have become more liberal in ending treatment and let die than before, or does this development rather reflect the development of more complex medicine due to the saving of more immature lives to a greater human cost?