Borderline viability resuscitation cases.

Abstract

Decisions on whether to resuscitate severely premature infants are especially difficult in "borderline viability" cases--those where the probability of survival is slim, and where, if survival is possible, multiple co-morbidities and severe disabilities are likely. The 2000 International Guidelines on Cardiopulmonary Resuscitation are comprehensive, yet leave open some of the more difficult ethical questions that must be addressed by decision-makers. This paper recommends evidence-based, clinical ethical guidelines for neonatal resuscitation, drawing on one large Catholic health system's approach, arguing from the perspective of the Catholic moral tradition and the Ethical and Religious Directives for Catholic Health Care Services (the ERD are policy for all of Catholic health care in the U.S.). The paper presumes that there is an inherent dignity of the human person to be respected and protected regardless of the nature of the person's health problem or social status. But it also presumes and argues that treatments can be justified only by a proportionate benefit to the patient. In maintaining a holistic view of the human person, two extremes are avoided: a "vitalistic" approach where life is preserved at all costs; and the "easy" alternative of euthanasia. Several principles of medicine, theology, ethics and Anglo-American common law are applied to three categories of preterm infants, each of which calls for a different basic response: Category I - infants with a confirmed gestational age of < 23-0/7 weeks; Category II - infants with a confirmed gestational age between 23-0/7 and 25-0/7 weeks; and Category III - infants with a gestational age > 25-0/7 weeks. Studies show that survival rates and outcomes vary dramatically for these three groups, even with the availability of the latest technologies.