Critical decision-making in neonatology and pediatrics: the I–P–O framework

Critical decision-making in neonatology and other areas of pediatrics often carries with it a complex and difficult ethical component. For any treatment under consideration, the impermissible–permissible–obligatory (I–P–O) spectrum provides a useful framework for determining how to proceed. Any prop...

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Bibliographic Details
Published in:Journal of perinatology 2021-01, Vol.41 (1), p.173-178
Main Authors: Mercurio, Mark R., Cummings, Christy L.
Format: Article
Language:English
Subjects:
692/700/1720
692/700/3935
Analysis
Decision making
Ethical aspects
Ethics
Management
Medical ethics
Medicine
Medicine & Public Health
Neonatology
Patients
Pediatric Surgery
Pediatrics
Perspective
Physicians
Toxicity
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Summary:Critical decision-making in neonatology and other areas of pediatrics often carries with it a complex and difficult ethical component. For any treatment under consideration, the impermissible–permissible–obligatory (I–P–O) spectrum provides a useful framework for determining how to proceed. Any proposed treatment can be located along this spectrum, and identified as either ethically impermissible, permissible, or obligatory. Treatments determined to be ethically impermissible should not be made available by physicians. Those deemed ethically permissible should be explained to parents, commonly with a specific recommendation. Informed parents should then be free to choose from among permissible options. Potential treatments deemed ethically obligatory should be provided to the patient, even in the face of parental objection. The fundamental ethical work in neonatology and pediatrics is determining where on the I–P–O spectrum a treatment under consideration should be located. This should be determined by the prognosis for the patient with and without the treatment, the feasibility of providing the treatment, and consideration of all relevant rights and obligations. Location on the line is dynamic, and clinicians should be open to movement of a given treatment along the spectrum as new information, particularly regarding effectiveness, toxicity, and/or alternatives, becomes available. This framework provides a structure for ethical conversation and decision-making related to a specific patient, as well as in the formation of institutional and national guidelines.
ISSN:0743-8346
1476-5543
DOI:10.1038/s41372-020-00841-6