Details

Autor(en) / Beteiligte

• Syltern, Janicke
• Ursin, Lars
• Solberg, Berge
• Støen, Ragnhild

Titel

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Ist Teil von

• American journal of bioethics, 2022-11, Vol.22 (11), p.15-26

Ort / Verlag

United States: Taylor & Francis

Erscheinungsjahr

2022

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.