June 2012, Vol 166, No. 6 >

< Previous Article

Full Content is available to subscribers

Subscribe/Learn More

Next Article >

Review Article | June 2012

Gestational Ageism

Dominic J. C. Wilkinson, MBBS, BMedSci, MBioeth, DPhil, FRACP

Arch Pediatr Adolesc Med. 2012;166(6):567-572. doi:10.1001/archpediatrics.2011.1262.

Text Size: A A A

Published online

Article

Figures

Tables

References

Comments

ABSTRACT

Published guidelines for resuscitation of extremely premature infants emphasize the importance of the gestational age of the infant. However, some ethicists and pediatricians have questioned these guidelines, suggesting that this may represent a form of discrimination. A policy of nonresuscitation of elderly patients older than a certain age would constitute a form of ageism and would likely be unacceptable to the broader community. Are resuscitation decisions for premature newborn infants analogous to resuscitation of elderly patients? Are current neonatal resuscitation guidelines discriminatory? This article looks at the relationship between discrimination based on gestational age and chronological age. There are 2 levels of gestational ageism and 2 separate strands of argument against gestational age guidelines. I conclude that resuscitation decisions for premature infants share many features with those for elderly patients, although there are also some relevant differences. I propose the use of gestational age equivalence as an alternative framework for practice.

Figures in this Article

Sign In to Access Full Content

Username

Password

Forgot Your Password?

Don't have Access?

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption

Grahic Jump Location

View Large | Save Figure | Download Slide (.ppt) | View in Article Context

Figure 1. A schematic representation of recent guidelines relating resuscitation decisions to gestational age in extremely premature infants. AAP indicates American Academy of Pediatrics; AHA, American Heart Association; BAPM, British Association of Perinatal Medicine; DPA, Dutch Pediatric Association; ERC, European Resuscitation Council; and UK, United Kingdom.

Place holder to copy figure label and caption

Grahic Jump Location

View Large | Save Figure | Download Slide (.ppt) | View in Article Context

Figure 2. Chances of survival and survival without profound impairment in infants receiving mechanical ventilation in the National Institute of Child Health and Development Neonatal Research Network centers between 1998 and 2003.¹⁰^- 11 The dotted line indicates more recent survival figures for infants receiving intensive care in California in 2005-2008.¹²

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Correspondence

Submit a Letter

CME

Accreditation Information

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

Note: You must get at least of the answers correct to pass this quiz.

Clear Answers | Save For Later

You have not filled in all the answers to complete this quiz

The following questions were not answered:

Sorry, you have unsuccessfully completed this CME quiz with a score of

The following questions were not answered correctly:

Commitment to Change (optional):

Indicate what change(s) you will implement in your practice, if any, based on this CME course.

Your quiz results:

The filled radio buttons indicate your responses. The preferred responses are highlighted

For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes

Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).

Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.

All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.

Instructions

Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.

Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.

* = Required Field

Comment Author(s)* (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.

Please disclose any conflicts of interest or check the box below.

No potential conflicts or relevant financial interests

Comment Title*

Comment*

Get Audio Code

Submit Cancel

Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Print
PDF
Email

AMA

You must be logged in and have an account to share content.

Return to: Gestational Ageism

This feature is provided as a courtesy. By using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to the AMA's Terms of Use. The information provided in order to email this article will not be shared, sold, traded, exchanged, or rented. Please refer to The JAMA Network's Privacy Policy for additional information.

© 2013 American Medical Association. All Rights Reserved.
Share
Get Citation

Wilkinson DC. Gestational Ageism. Arch Pediatr Adolesc Med. 2012;166(6):567-572. doi:10.1001/archpediatrics.2011.1262.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

© American Medical Association
Get Permissions
Get Alerts

Processing your request... Please Wait.
Submit a Letter
Submit a Comment

Sign In to Access Full Content

Username

Password

Forgot Your Password?

Full Content is available to subscribers

Gestational Ageism

ABSTRACT

Figures in this Article

Topics

Sign In to Access Full Content

Don't have Access?

Figures

Tables

Interactive Graphics

Video

References

Correspondence

Sign In

Don't have Access?

Sign In to Access Full Content

Related Content

JAMA Pediatrics

Content

Services

The JAMA Network

Sites

AMA Publishing Group Journals

Information For

Services

Content Resources

Other Resources

Sign In

Register for a FREE personal account

Want to Subscribe?

Don't have Access?

Forgot Your Password?