Postponed Withholding : Balanced Decision-Making at the Margins of Viability
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.
| Errataetall: |
CommentIn: Am J Bioeth. 2022 Nov;22(11):46-48. - PMID 36332034 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
The American journal of bioethics : AJOB - 22(2022), 11 vom: 13. Nov., Seite 15-26 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Syltern, Janicke [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Children and families |
|---|
| Anmerkungen: |
Date Completed 08.11.2022 Date Revised 27.02.2024 published: Print-Electronic CommentIn: Am J Bioeth. 2022 Nov;22(11):46-48. - PMID 36332034 Citation Status MEDLINE |
|---|
| doi: |
10.1080/15265161.2021.1925777 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM325502234 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM325502234 | ||
| 003 | DE-627 | ||
| 005 | 20240229163231.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1080/15265161.2021.1925777 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1308.xml |
| 035 | |a (DE-627)NLM325502234 | ||
| 035 | |a (NLM)33998962 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Syltern, Janicke |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Postponed Withholding |b Balanced Decision-Making at the Margins of Viability |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 08.11.2022 | ||
| 500 | |a Date Revised 27.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Am J Bioeth. 2022 Nov;22(11):46-48. - PMID 36332034 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Children and families | |
| 650 | 4 | |a decision-making | |
| 650 | 4 | |a end-of-life issues | |
| 650 | 4 | |a pediatrics: neonatology | |
| 650 | 4 | |a professional-patient relationship | |
| 700 | 1 | |a Ursin, Lars |e verfasserin |4 aut | |
| 700 | 1 | |a Solberg, Berge |e verfasserin |4 aut | |
| 700 | 1 | |a Støen, Ragnhild |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The American journal of bioethics : AJOB |d 2001 |g 22(2022), 11 vom: 13. Nov., Seite 15-26 |w (DE-627)NLM116966998 |x 1536-0075 |7 nnns |
| 773 | 1 | 8 | |g volume:22 |g year:2022 |g number:11 |g day:13 |g month:11 |g pages:15-26 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1080/15265161.2021.1925777 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 22 |j 2022 |e 11 |b 13 |c 11 |h 15-26 | ||