1. Postponed Withholding: Balanced Decision-Making at the Margins of Viability
- Author
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Lars Øystein Ursin, Berge Solberg, Janicke Marita Syltern, and Ragnhild Støen
- Subjects
Parents ,Palliative care ,media_common.quotation_subject ,Decision Making ,Resistance (psychoanalysis) ,0603 philosophy, ethics and religion ,Nursing ,Pregnancy ,Health care ,Humans ,VDP::Medisinske Fag: 700 ,media_common ,business.industry ,Health Policy ,Palliative Care ,Infant, Newborn ,06 humanities and the arts ,Directive ,VDP::Medical disciplines: 700 ,Issues, ethics and legal aspects ,Instinct ,Withholding Treatment ,Life support ,Ethical dilemma ,Female ,060301 applied ethics ,Neonatology ,business ,Psychology - Abstract
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.
- Published
- 2021