It is important to note that there is a complex and multifaceted relationship between premature birth and bioethics. The former is a significant ethical as well as medical challenge, which can be categorized into four key bioethical perspectives. Firstly, premature birth poses an ethical problem with respect to life-sustaining treatment and its continuation. Secondly, the issue concerns neonatal research and ethical limits known by the involved parties. Thirdly, informed consent is critical since all stakeholders need to be aware of both the costs and consequences of caring for a prematurely born patient. Fourthly, premature birth is an ethical dilemma because it can be resource intensive, which is why the decision-making needs to account for it.
The first aspect of ethics and premature birth is life-sustaining treatment since it is a complex issue, especially in neonatal intensive care settings. One of the most critical bioethical perspectives related to this issue concerns the decision-making process regarding the withholding or withdrawal of life-sustaining treatment. The research revealed that doctors who placed a greater emphasis on the importance of the quality of human life were more likely to choose to withhold or withdraw neonatal intensive care (Dagla et al., 2020). In other words, the decision to withhold or withdraw life-sustaining treatment is a critical ethical consideration. Thus, physicians must balance the value of quality of life against the potential harm of medical intervention. The ethical principle of beneficence requires that doctors act in the best interest of their patients, which is why this can be complicated by competing ethical principles, such as autonomy and justice. As a result, ethical awareness, as well as sensitivity, are crucial in navigating the continuation of the treatment.
The second aspect of the subject is the ethics of neonatal research. Evidence suggests that “physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care” (Chatziioannidis et al., 2020, p. 1). In other words, those who value the sanctity of life are more likely to continue intensive care. In addition, the level of education of physicians, their participation in research, religious beliefs, and their stance on the current legal framework were all factors that had an impact on their attitude score (Chatziioannidis et al., 2020, p. 1). Thus, physicians with a greater familiarity with the potential consequences of continued treatment are aware of the chances and the quality of life implications of their efforts. In other words, their expertise and leaning towards valuing quality-of-life is determined by their knowledge of data and evidence rather than religious convictions.
The third critical aspect of bioethics and premature birth involves informed consent. It is stated that “nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end” (Kaempf & Moore, 2023, p. 1). Therefore, it is necessary to make judgments about the situation and decisions on how to proceed by being fully informed on what will be the future ramifications. Some late premature births might have no reduction in quality of life, but early ones can be detrimental, which is why a clear understanding is needed by all involved parties. All sides require pragmatism alongside dialogue to reach a mutual understanding, which means the sentiments, emotions, and feelings should not be completely dismissed as irrelevant. The most ethical method would be achieving a collective consciousness and awareness about the situation.
The fourth and final important aspect of the issue is about costs and the ethics of resource allocation. In accordance with the Shared Decision Making framework, “if these empowered parents demand endless treatment that is considered futile by healthcare providers, the psychological costs to healthcare providers and the economic costs of treatment will be enormous” (Akabayashi et al., 2022, p. 496). This can be categorized as the most ethically sound way to address such a sensitive dilemma. It not only promotes communication and informed consent but enables a greater degree of openness about the costs compared to outcomes. In other words, parents should not be put on a pedestal of decision-making because continued care affects the providers of care as well. They need to voice their concerns as loudly as the parents in order to ensure that a compromise is reached. Trying to be silent on matters of cost only creates a sense of distrust and false hope.
In conclusion, premature birth is a complex issue that poses significant bioethical challenges in terms of life-sustaining treatment, neonatal research, informed consent, and resource allocation. The decision to withhold or withdraw life-sustaining treatment is a critical ethical consideration, and physicians must balance the value of quality of life against the sanctity of life. In the case of the ethics of neonatal research, physicians need to have a greater familiarity with the potential consequences of continued treatment to be aware of the chances and quality of life implications of their efforts. When trying to achieve informed consent, a collective consciousness via dialogics and pragmatism is necessary to make judgments about the situation and decisions on how to proceed. The ethics of resource allocation is important as well, and the Shared Decision Making framework promotes communication and informed consent among all stakeholders.
References
Akabayashi, A., Nakazawa, E., & Ino, H. (2022). Ethics of treatment decisions for extremely premature newborns with poor prognoses: Comparison of shared decision making in norway and japan. Pediatric Reports, 14(4), 491-496. Web.
Chatziioannidis, I., Iliodromiti, Z., Boutsikou, T., Pouliakis, A., Giougi, E., Sokou, R., Vidalis, T., Xanthos, T., Marina, C., & Iacovidou, N. (2020). Physicians’ attitudes in relation to end-of-life decisions in neonatal intensive care units: A national multicenter survey. BMC Medical Ethics, 21, 1-10. Web.
Dagla, M., Petousi, V., & Poulios, A. (2020). Bioethical decisions in neonatal intensive care: Neonatologists’ self-reported practices in greek NICUs. International Journal of Environmental Research and Public Health, 17(10), 3465. Web.
Kaempf, J. W., & Moore, G. P. (2023). Extremely premature birth bioethical decision-making supported by dialogics and pragmatism. BMC Medical Ethics, 24, 1-9. Web.