Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard

• Published in: Journal of perinatology Vol. 36; no. 10; pp. 906 - 911
• Main Authors: Placencia, F X, Ahmadi, Y, McCullough, L B
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.10.2016; Nature Publishing Group
• Subjects: 692/700/3935; 706/648/179; Abnormalities, Multiple - therapy; Adult; Aged; Aged, 80 and over; Analysis; Attitude of Health Personnel; Babies; Best interests of the child doctrine; Bioethical Issues; Bioethics; Decision Making - ethics; Design standards; Ethicists; Ethics; Euthanasia, Passive - ethics; Family - psychology; Female; Humanities; Humans; Infant; Infant, Newborn; Infants; Male; Medical schools; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neonatal care; Neonates; Neonatologists; original-article; Ostomy; Pediatric Surgery; Pediatrics; Practice; Practice Patterns, Physicians; Statistics, Nonparametric; Surveys; Surveys and Questionnaires; United States; United States; United States > US; Texas
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2016.87

Objective: The objective of this study is to determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS). Study Design: Members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life-sustaining therapy (LST). Results: Neonatologists’ median response supported an infant-specific BIS conceptualization that linked the infant’s and family’s interests. They did not support allowing limitations on the family’s obligations. Ethicists’ supported a conceptualization that linked the infant’s and family’s interests and limitations on the family’s obligations, a less infant-specific conceptualization. Ethicists were less or equally likely to agree with forgoing LST in seven of eight cases. Conclusions: Ethicists endorsed a conceptualization of the BIS that includes the effects on the family and rejected an infant-specific one. Neonatologists split between these two and rejected limiting the family’s obligations. Critical appraisal of the BIS is needed in neonatal ethics.