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When operating is considered futile: Difficult decisions in the neonatal intensive care unit

2009; Elsevier BV; Volume: 146; Issue: 1 Linguagem: Inglês

10.1016/j.surg.2009.03.029

1532-7361

Nicole K. Yamada, Ira J. Kodner, Douglas Brown,

Childhood Cancer Survivors' Quality of Life

CME Information Through joint sponsorship with the American College of Surgeons, the quarterly Ethics articles published by SURGERY will now offer the reader the option of earning 1 CME credit per article. These articles can be used to earn credit for three years from the time of publication. To receive a CME certificate, participants must read the article and successfully complete a short post-test and evaluation form based on the Ethics article. Additional information, the article in its entirety, the test/evaluation, and certificate are located on the American College of Surgeons website: http://www.facs.org/education/SURGERYethicsarticles.html. The system requirements are as follows: Adobe® Reader 7.0 or above installed; Internet Explorer® 6 and above; Firefox® 1.0 and above or Safari™ 2.0 and above. Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the American College of Surgeons and SURGERY. The American College of Surgeons is accredited by the ACCME to provide continuing medical education for physicians. AMA PRA Category 1 Credits™ The American College of Surgeons designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Disclosure Information In accordance with ACCME regulations, the American College of Surgeons, as the accredited provider of this journal CME, must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant financial relationships with any commercial interest. The editor and author(s) of this article were required to complete disclosures and any reported conflicts have been managed to our satisfaction. However, if you perceive a bias within the article, please advise us of the circumstances on the evaluation form. The requirement for disclosure is not intended to imply any impropriety of such relationships, but simply to identify such relationships through full disclosure, and to allow readers to form their own judgments regarding the material. Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: Nicole K. Yamada has no significant relationships to disclose. Ira J. Kodner has no significant relationships to disclose. Douglas E. Brown has no significant relationships to disclose. Objective The learning objectives provided by this ethical challenge involving a premature neonate with severe and irreversible congenital abnormalities, where surgeons are consulted to consider extensive high-risk procedures in what is probably a futile situation include (1) understanding the surgical differentiation between what could be done using extreme surgical procedures and what should be done to deal ethically with the situation, taking into account the needs of the patient and her parents; (2) understanding the magnitude of the struggle to help desperate parents to comprehend enough of the complex medical situation to participate in the decisions related to their newborn child; (3) learning to evaluate the risk/benefit ratio of possible procedures that will probably not improve the duration nor the quality of life for the patient; (4) learning the benefits of appropriate consultation with the hospital ethics consultation service; and (5) appreciating the importance of implementing basic principles of medical ethics, especially the balance between beneficence and nonmaleficence, and the meaning of autonomy when it comes to decisions for a severely ill neonate. An infant girl was born at 25 and 2/7 weeks' gestation to a 17-year-old mother via primary Cesarean section. The infant was intubated at 10 minutes of life and transferred to the neonatal intensive care unit (NICU), where she continued to require ventilatory assistance. Through joint sponsorship with the American College of Surgeons, the quarterly Ethics articles published by SURGERY will now offer the reader the option of earning 1 CME credit per article. These articles can be used to earn credit for three years from the time of publication. To receive a CME certificate, participants must read the article and successfully complete a short post-test and evaluation form based on the Ethics article. Additional information, the article in its entirety, the test/evaluation, and certificate are located on the American College of Surgeons website: http://www.facs.org/education/SURGERYethicsarticles.html. The system requirements are as follows: Adobe® Reader 7.0 or above installed; Internet Explorer® 6 and above; Firefox® 1.0 and above or Safari™ 2.0 and above. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the American College of Surgeons and SURGERY. The American College of Surgeons is accredited by the ACCME to provide continuing medical education for physicians. The American College of Surgeons designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. In accordance with ACCME regulations, the American College of Surgeons, as the accredited provider of this journal CME, must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant financial relationships with any commercial interest. The editor and author(s) of this article were required to complete disclosures and any reported conflicts have been managed to our satisfaction. However, if you perceive a bias within the article, please advise us of the circumstances on the evaluation form. The requirement for disclosure is not intended to imply any impropriety of such relationships, but simply to identify such relationships through full disclosure, and to allow readers to form their own judgments regarding the material. Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: Nicole K. Yamada has no significant relationships to disclose. Ira J. Kodner has no significant relationships to disclose. Douglas E. Brown has no significant relationships to disclose. The learning objectives provided by this ethical challenge involving a premature neonate with severe and irreversible congenital abnormalities, where surgeons are consulted to consider extensive high-risk procedures in what is probably a futile situation include (1) understanding the surgical differentiation between what could be done using extreme surgical procedures and what should be done to deal ethically with the situation, taking into account the needs of the patient and her parents; (2) understanding the magnitude of the struggle to help desperate parents to comprehend enough of the complex medical situation to participate in the decisions related to their newborn child; (3) learning to evaluate the risk/benefit ratio of possible procedures that will probably not improve the duration nor the quality of life for the patient; (4) learning the benefits of appropriate consultation with the hospital ethics consultation service; and (5) appreciating the importance of implementing basic principles of medical ethics, especially the balance between beneficence and nonmaleficence, and the meaning of autonomy when it comes to decisions for a severely ill neonate.