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
Identifier
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
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Citation List Month
July 2021 List
URL Address
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 April 27, 2025, https://pedpalascnetlibrary.omeka.net/items/show/17610.