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Syltern J. Scandinavian perspectives on life support at the border of viability. Front Pediatr 2024; 12:1394077. [PMID: 38720944 PMCID: PMC11076765 DOI: 10.3389/fped.2024.1394077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
Advances in neonatal medicine have allowed us to rescue extremely preterm infants. However, both long-term vulnerability and the burden of treatment in the neonatal period increase with decreasing gestational age. This raises questions about the justification of life support when a baby is born at the border of viability, and has led to a so-called "grey zone", where many professionals are unsure whether provision of life support is in the child's best interest. Despite cultural, political and economic similarities, the Scandinavian countries differ in their approach to periviable infants, as seen in their respective national guidelines and practices. In Sweden, guidelines and practice are more rescue-focused at the lower end of the border of viability, Danish guidelines emphasizes the need to involve parental views in the decision-making process, whereas Norway appears to be somewhere in between. In this paper, I will give an overview of national consensus documents and practices in Norway, Sweden and Denmark, and reflect on the ethical justification for the different approaches.
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Affiliation(s)
- Janicke Syltern
- Department of Neonatology, St. Olavs Hospital University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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2
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Vidaeff AC, Kaempf JW. The Ethics and Practice of Periviability Care. CHILDREN (BASEL, SWITZERLAND) 2024; 11:386. [PMID: 38671603 PMCID: PMC11049503 DOI: 10.3390/children11040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Since the 1960s, the gestational age at which premature infants typically survive has decreased by approximately one week per decade [...].
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Affiliation(s)
- Alex C. Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Hospital Pavilion for Women, 6651 Main Street, Suite F1020, Houston, TX 77030, USA
| | - Joseph W. Kaempf
- Women & Children’s Institute, Providence Health System Oregon, Portland, OR 97232, USA;
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3
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Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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Arnold C, Inthorn J, Roth B, Matheisl D, Tippmann S, Mildenberger E, Kidszun A. Attitudes and values towards decisions at the margin of viability among expectant mothers at risk for preterm birth. Acta Paediatr 2024; 113:442-448. [PMID: 37942656 DOI: 10.1111/apa.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
AIM To explore how expectant mothers at risk for preterm birth would like to be involved in decision-making at the margin of viability and what they would base their decisions on. METHODS This cross-sectional observational study included a mixed-methods post-hoc analysis alongside a previously reported randomised clinical trial. Expectant mothers between 280/7 and 366/7 weeks' gestation who were hospitalised for risk of preterm birth responded to written case vignettes of an impending preterm birth at the margin of viability. Participants responded to closed and open-ended questions that were theoretically coded for attitudes and values towards shared decision-making. RESULTS Sixty-four expectant mothers were included in the analysis, 36 provided written perspectives. Decision-making was perceived as an enormous burden and a potential source of guilt and regret. Weighing personal values in terms of 'fighting for the baby' and 'quality of life' were used to inform the decision-making process. Explicitly stating that any decision is a good decision, empowerment through co-constructing shared decisions rather than simply presenting choices, sharing the clinicians' personal views, and honest, and empathetic counselling were perceived as supportive. CONCLUSION Mothers at risk for preterm birth provided specific insights into their decision-making patterns that may be helpful to clinicians.
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Affiliation(s)
- Christine Arnold
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia Inthorn
- Center for Health Care Ethics, Hanover, Germany
- Institute for the History, Philosophy, and Ethics of Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | | | - Daniel Matheisl
- Division of Neonatology and Pediatric Intensive Care, Center for Pediatrics, Medical Center of the University of Freiburg, Freiburg, Germany
| | - Susanne Tippmann
- Department of Neonatology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Eva Mildenberger
- Department of Neonatology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - André Kidszun
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neonatology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Guillén Ú, Zupancic JAF, Litt JS, Kaempf J, Fanaroff A, Polin RA, Martin R, Eichenwald E, Wilson-Costello D, Edwards AD, Hallman M, Bührer C, Fanaroff J, Albersheim S, Embleton ND, Shah PS, Dennery PA, Discenza D, Jobe AH, Kirpalani H. Community Considerations for Aggressive Intensive Care Therapy for Infants <24+0 Weeks of Gestation. J Pediatr 2024; 268:113948. [PMID: 38336203 DOI: 10.1016/j.jpeds.2024.113948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Affiliation(s)
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan S Litt
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | - Joseph Kaempf
- Women and Children's Services, Providence St. Vincent Medical Center, Portland, OR
| | - Avroy Fanaroff
- Emeritus, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Richard Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eric Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - A David Edwards
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mikko Hallman
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Fanaroff
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia, Vancouver, BC, Canada
| | | | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Phyllis A Dennery
- Warren Alpert School of Medicine of Brown University, Providence, RI
| | | | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and University of Cincinnati, Cincinnati, OH
| | - Haresh Kirpalani
- Emeritus, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, and Emeritus Department Pediatrics, McMaster University, Hamilton, ON, Canada
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Thorvilson MJ, Carroll K, Kaemingk BD, Schaepe KS, Collura CA. The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study. Matern Health Neonatol Perinatol 2023; 9:15. [PMID: 38037157 PMCID: PMC10691151 DOI: 10.1186/s40748-023-00168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. METHODS This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists' discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. RESULTS In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus's presence, and (iii) fetal role in decision-making. CONCLUSION Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.
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Affiliation(s)
- Megan J Thorvilson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA.
| | - Katherine Carroll
- School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Bethany D Kaemingk
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Sanford Children's Hospital, Fargo, ND, USA
- Department of Pediatrics, University of North Dakota, Grand Forks, ND, USA
| | - Karen S Schaepe
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Christopher A Collura
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
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Wilkinson DJ, Bertaud S. End of life care in the setting of extreme prematurity - practical challenges and ethical controversies. Semin Fetal Neonatal Med 2023; 28:101442. [PMID: 37121832 PMCID: PMC10914670 DOI: 10.1016/j.siny.2023.101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
While the underlying principles are the same, there are differences in practice in end of life decisions and care for extremely preterm infants compared with other newborns and older children. In this paper, we review end of life care for extremely preterm infants in the delivery room and in the neonatal intensive care unit. We identify potential justifications for differences in the end of life care in this population as well as practical and ethical challenges.
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Affiliation(s)
- Dominic Jc Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore.
| | - Sophie Bertaud
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK
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Kornhauser Cerar L, Lucovnik M. Ethical Dilemmas in Neonatal Care at the Limit of Viability. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050784. [PMID: 37238331 DOI: 10.3390/children10050784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Advances in neonatal care have pushed the limit of viability to incrementally lower gestations over the last decades. However, surviving extremely premature neonates are prone to long-term neurodevelopmental handicaps. This makes ethics a crucial dimension of periviable birth management. At 22 weeks, survival ranges from 1 to 15%, and profound disabilities in survivors are common. Consequently, there is no beneficence-based obligation to offer any aggressive perinatal management. At 23 weeks, survival ranges from 8 to 54%, and survival without severe handicap ranges from 7 to 23%. If fetal indication for cesarean delivery appears, the procedure may be offered when neonatal resuscitation is planned. At a gestational age ≥24 weeks, up to 51% neonates are expected to survive the neonatal period. Survival without profound neurologic disability ranges from 12 to 38%. Beneficence-based obligation to intervene is reasonable at these gestations. Nevertheless, autonomy of parents should also be respected, and parental consent should be sought prior to any intervention. Optimal counselling of parents involves harmonized cooperation of obstetric and neonatal care providers. Every fetus/neonate and every pregnant woman are different and have the right to be considered individually when treatment decisions are being made.
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Affiliation(s)
- Lilijana Kornhauser Cerar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Zaloska 11, 1525 Ljubljana, Slovenia
| | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Zaloska 11, 1525 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
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Krick JA, Feltman DM, Arnolds M. Decision-Making for Extremely Preterm Infants: A Qualitative Systematic Review. J Pediatr 2022; 251:6-16. [PMID: 35940293 DOI: 10.1016/j.jpeds.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To synthesize and describe important elements of decision-making during antenatal consultation for threatened preterm delivery at the margin of gestational viability. STUDY DESIGN Data sources including PubMed, EMBASE, Web of Science, and CINAHL Plus were searched. We included all qualitative literature published on decision-making from 1990 to July 2021. Two authors independently screened and evaluated each study using the Critical Appraisal Skills Programme checklist; studies reaching moderate and high quality were included. We developed an extraction tool to collect and categorize data from each qualitative article, then used thematic analysis to analyze and describe the findings. RESULTS Twenty-five articles incorporating the views of 504 providers and 352 parents were included for final review. Thematic analysis revealed 4 main themes describing the experience of health care providers and parents participating in decision-making: factors that influence decision-making, information sharing, building a partnership, and making the decision. Parents and providers were not always in agreement upon which elements were most essential to the process of decision-making. Articles published in languages other than English were excluded. CONCLUSIONS Qualitative literature highlighting key factors which are important during antenatal counseling can inform and guide providers through the process of shared decision-making. Communicating clear, honest, and balanced information; avoiding artificially dichotomized options; and focusing on partnership building with families will help providers use the antenatal consultation to reach personalized decisions for each infant.
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Affiliation(s)
- Jeanne A Krick
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX.
| | - Dalia M Feltman
- Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University Health System, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Marin Arnolds
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Ethics of Treatment Decisions for Extremely Premature Newborns with Poor Prognoses: Comparison of Shared Decision Making in Norway and Japan. Pediatr Rep 2022; 14:491-496. [PMID: 36412664 PMCID: PMC9680241 DOI: 10.3390/pediatric14040057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Ethical debates about the life-prolonging treatment of extremely premature infants and infants with congenital abnormalities with poor prognoses have long been held. We will examine approaches in Norway and Japan as examples because Norway is a well-known welfare state. By comparing the traditional Norwegian approach, the newly proposed approach of postponed withholding (PPWH) and the Japanese approach, we will revisit shared decision making in neonatology in general, where patients (i.e., newborns) inevitably have no decision-making capacity. We argue that in shared decision making, the process is critical, and that it is important to clarify who will be the final decision-maker and whose benefits are most important. In addition, we argue that the issue of cost cannot be avoided in this current time of economic disparities in global health. Shared decision making should not be a mere formality. These are significant examples of new ethical debates to be discussed in the modern era in the neonatology field.
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Kaempf JW, Dirksen KM. The Birth of Tragedy? Extremely Premature Births and Shared Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:59-66. [PMID: 36332042 DOI: 10.1080/15265161.2022.2123981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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12
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De Proost L, Bunnik E, de Boer A, Verweij EJJ. Postponed Withholding: Harmful for the Infant and Increasing the Complexity of Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:56-59. [PMID: 36332056 DOI: 10.1080/15265161.2022.2123978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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13
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Lantos JD. Should We Aspire to Be Rational About Letting Babies Die? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:51-53. [PMID: 36332043 DOI: 10.1080/15265161.2022.2123984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Pope TM. Use Certified Patient Decision Aids to Facilitate Shared Decision Making at the Margins of Viability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:49-51. [PMID: 36332055 DOI: 10.1080/15265161.2022.2123979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Verhagen AAEE. Optimizing Decision-Making in the Gray Zone at Birth. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:1-3. [PMID: 36332035 DOI: 10.1080/15265161.2022.2132317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Mercurio MR. The Path More Easily Reversed: Postponed Withholding at Borderline Viability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:35-37. [PMID: 36332037 DOI: 10.1080/15265161.2022.2123985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Cavolo A. Embrace the Gray: How Tackling the Clinical Complexities of the Gray Zone Will Improve Decision-making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:40-43. [PMID: 36332041 DOI: 10.1080/15265161.2022.2123982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Gillam L, Prentice TM. What Is the Ethical Goal of Empowering Parents in Emergent Decision-making about Their Premature Newborn? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:38-40. [PMID: 36332046 DOI: 10.1080/15265161.2022.2123991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Lynn Gillam
- University of Melbourne
- Royal Children's Hospital
| | - Trisha M Prentice
- University of Melbourne
- Royal Children's Hospital
- Murdoch Children's Research Institute
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Anani U, Tucker Edmonds B, Andrews BL, Famuyide M, Feltman D. Default Withdrawal: Exacerbating Mistrust for Our Most Vulnerable Families. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:46-48. [PMID: 36332034 DOI: 10.1080/15265161.2022.2123980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Kukora S, Laventhal N, Arnolds M. Postponed Withholding: The Wrong Nudge. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:66-69. [PMID: 36332050 DOI: 10.1080/15265161.2022.2123977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Kon NM, Kon AA. Informed Nondissent at the Limits of Viability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:54-56. [PMID: 36332049 DOI: 10.1080/15265161.2022.2123974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Janvier A, Barrington KJ. Delayed Withholding: Disguising Withdrawal of Life Sustaining Interventions in Extremely Preterm Infants. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:43-46. [PMID: 36332036 DOI: 10.1080/15265161.2022.2123986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Annie Janvier
- Université de Montréal
- CHU Sainte-Justine Research Center
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Wilkinson DJC. Deferring Decision-making in the Face of Uncertainty. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:30-33. [PMID: 36332048 DOI: 10.1080/15265161.2022.2123975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Carter BS. Postponed Withholding Does Not Postpone Attachment. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:27-30. [PMID: 36332047 DOI: 10.1080/15265161.2022.2123990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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