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Decisions Regarding Resuscitation of Extremely Premature Infants Should Social Context Matter?

Renee D. Boss, MD, MHS1; Carrie M. Henderson, MD2; Benjamin S. Wilfond, MD3
[+] Author Affiliations
1Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
2Division of Pediatric Critical Care Medicine, Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, Jackson
3Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle
JAMA Pediatr. 2015;169(6):521-522. doi:10.1001/jamapediatrics.2014.3813.
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This Viewpoint discusses the importance of effective patient-physician communication when addressing high-stakes medical decisions.

Even with full resuscitation efforts, 2 of 3 newborns delivered at 23 weeks’ gestation die. Approximately 90% of survivors have moderate to serious disability.1 These unpredictable and life-threatening outcomes inform professional standards that neonatal resuscitation is justified when the parents determine the risks are reasonable. To clinicians, similar treatment requests may feel more reasonable or less reasonable, given the particular family circumstances and the potential effect on the newborn’s interests. This issue raises an important question about whether social context should matter when responding to parents’ requests for resuscitation. In this Viewpoint, we present 2 hypothetical case scenarios based on our experience with these situations.

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