Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Title

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Creator

Syltern J; Ursin L; Solberg B; Støen R

Publisher

American Journal of Bioethics

Date

2021

Subject

decision-making; end-of-life issues; Children and families; professional-patient relationship; pediatrics: neonatology

Description

Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

July 2021 List

Collection

Citation

Syltern J; Ursin L; Solberg B; Støen R, “Postponed Withholding: Balanced Decision-Making at the Margins of Viability,” Pediatric Palliative Care Library, accessed October 28, 2021, https://pedpalascnetlibrary.omeka.net/items/show/17610.

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