Is Treatment Futile for an Extremely Premature Infant With Giant Omphalocele?

Doctors have no ethical obligation to provide futile treatment. This has been true since the time of Hippocrates who warned physicians not to treat patients who were "overmastered by their disease." This principle remains valid today but, as the Society for Critical Care Medicine notes, it...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2014, Vol.133 (1), p.123-128
Main Authors: FELTMAN, Dalia, STOKES, Theophil, KETT, Jennifer, LANTOS, John D
Format: Article
Language:English
Subjects:
Abdomen
Biological and medical sciences
Birth defects
Care and treatment
Company business management
Ethics
Evaluation
Family physicians
Female
Frustration
General aspects
Health aspects
Hernia
Hernia, Umbilical - therapy
Herniorrhaphy - ethics
Humans
Infant, Extremely Premature
Infant, Newborn
Infant, Premature, Diseases - therapy
Infants (Premature)
Intensive Care, Neonatal - ethics
Management
Medical ethics
Medical Futility - ethics
Medical sciences
Navel
Neonatology - ethics
Palliative care
Palliative Care - ethics
Palliative treatment
Pediatrics
Physicians
Practice
Premature birth
Premature infants
Professional-Family Relations - ethics
Public health. Hygiene
Public health. Hygiene-occupational medicine
Resuscitation - ethics
Teaching. Deontology. Ethics. Legislation
Umbilical hernia
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Summary:Doctors have no ethical obligation to provide futile treatment. This has been true since the time of Hippocrates who warned physicians not to treat patients who were "overmastered by their disease." This principle remains valid today but, as the Society for Critical Care Medicine notes, it is difficult to identify treatment as absolutely futile in all but a few clinical situations. Far more common, they note, are "treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit." These, they say, "may be considered inappropriate and hence inadvisable, but should not be labeled futile." So what should doctors do when they have a case that seems close to the futility threshold but does not, perhaps, quite cross it? In such cases, is it appropriate to make unilateral decisions to withhold life-sustaining treatment even if the family objects? Or should treatment be provided knowing that it might cause pain and suffering to an infant with no likelihood of benefit? To address these questions, we present a case of an extremely premature infant with a giant omphalocele and ask 3 neonatologists, Dr Dalia Feltman of Evanston Hospital, Dr Theophil Stokes of the Walter Reed Medical Center, and Dr Jennifer Kett, a neonatologist and fellow in bioethics at Seattle Children's Hospital, to comment.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2013-1001