Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1219-1222 (doi:10.1542/peds.2004-2790)
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EXPERIENCE AND REASON

Medical Futility in the Neonatal Intensive Care Unit: Hope for a Resolution

Robert L. Fine, MD*,{ddagger}, Jonathan M. Whitfield, MBChB§, Barbara L. Carr, MD§ and Thomas W. Mayo, JD*,¶

* Office of Clinical Ethics, Baylor Health Care System, Dallas, Texas
{ddagger} Department of Internal Medicine
§ Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
Southern Methodist University, Dedman School of Law, Dallas, Texas

Contemporary medical practice in the NICU sometimes leads to conflicts between providers and parents in which the parent demands continuation of life-sustaining treatment that the medical team deems medically inappropriate or futile. Such conflicts can be difficult to resolve and trying for all parties. Here we describe a conflict involving a 25-week-gestation, 825-g newborn with multiple intractable medical problems and resolution of the conflict through ethics consultation under provisions of the Texas Advance Directives Act. The process established under Texas law sets conceptual and temporal boundaries around the problem of medical futility and provides a legal safe harbor for physicians who seek to withdraw life-sustaining treatments in the setting of medical futility, allowing resolution of such conflicts in a timely and effective manner. As such, it may provide a model for physicians in other states to follow.

Key Words: conflict resolution • end of life • ethics • intensive care • futility

Abbreviations: AAP, American Academy of Pediatrics • CPR, cardiopulmonary resuscitation • DOL, day of life

Accepted Mar 2, 2005.


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