PROLONGING LIFE AND ALLOWING DEATH - INFANTS

Dilemmas about resuscitation and life-prolonging treatment for severel y compromised infants have become increasingly complex as skills in ne onatal care have developed. Quality of life and resource issues necess arily influence management. Our Institute of Medical Ethics working pa rty, on whose behalf this paper is written, recognises that the ultima te responsibility for the final decision rests with the doctor in clin ical charge of the infant. However, we advocate a team approach to dec ision-making, emphasising the important role of parents and nurses in the process. Assessing the relative burdens and benefits cart be troub ling, but doctors and parents need to retain a measure of discretion; legislation which would determine action in all cases is inappropriate . Caution should be exercised in involving committees in decision-maki ng and, where they exist, their remit should remain to advise rather t han to decide. Support for families who bear the consequences of their decisions is often inadequate, and facilitating access to such servic es is pan of the wider responsibilities of the intensive care team. Th e authors believe that allowing death by withholding or withdrawing tr eatment is legitimate, where those closely involved in the care of the infant together deem the burdens to be unacceptable without compensat ing benefits for the infant. As pan of the process accurate and carefu l recording is essential.