Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 288 (doi:10.1542/peds.2005-0773)

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First Rule: Choose Your Battles Wisely

Irene Hurst, PhD, RN
Department of Nursing,
New Mexico State University,
Las Cruces, NM 88003

To the Editor.

I disagree with Dr Kopelman's analysis of the 21-year-old "Baby Doe" rules and her call for the American Academy of Pediatrics (AAP) to withdraw what she characterized as its "apparent" support for those rules.¹ She argues that the Baby Doe rules are incompatible with other AAP recommendations to use the best-interest standard for decision-making for the care of infants. Dr Kopelman believes that neonatologists, who interpret the current Baby Doe rules to allow considerable discretion for individualized decision-making, are wrong. To the contrary, I think that the AAP recommendations are not in contradiction with the Baby Doe rules precisely because of the ambiguity of the rules.

I think that the strongest evidence that ambiguity exists in the rules is that no state has prosecuted a single doctor, nurse, medical institution, or family under these regulations.² This is true despite the fact that many neonatologists follow the AAP recommendations, which Dr Kopelman argues are in direct conflict with the rules. In a society as litigious as the United States, especially on these life-and-death decisions, that is about the best signal there is that these regulations are not in conflict with the AAP recommendations.

The real problem Dr Kopelman identifies is the fear of prosecution that some neonatologists continue to express because of the existence of these rules. She cites a case study³ in which family and providers agreed that forgoing aggressive life-sustaining treatment was in the infant's best interest, but physicians continued aggressive treatment based on their interpretation of the Baby Doe rules. I think this case brought out a glaring error on the part of the health care team involved. They made a decision based on a legal analysis without bringing any legal expert(s) into the process.

Dr Kopelman also refers to a survey⁴ that she conducted >17 years ago that showed that neonatologists felt that the rules interfered with parental rights and professional prerogatives. I suggest that some education is essential if such attitudes persist.

I suggest that health care providers faced with these difficult life-and-death treatment decisions are better served with some in-service education about the real impact of the regulations. No less important would be the inclusion of expert legal advice on any health care team confronting such difficult decisions. Getting involved in a legislative battle, or regulatory struggle, to change the regulations is a battle unnecessary now and certainly would drain resources better used for serving clients.

REFERENCES

1. Kopelman LM. Are the 21-year-old Baby Doe rules misunderstood or mistaken [commentary]? Pediatrics.2005; 115 :797 –802[Free Full Text]
2. Hurst I. The legal landscape at the threshold of viability for extremely premature infants: a nursing perspective–Part I. J Perinat Neonatal Nurs.2005; In press
3. National Hospice Organization. Standards of a Hospice Program of Care. Arlington, VA: National Hospice Organization;1990[Abstract/Free Full Text]
4. Kopelman LM, Kopelman AE, Irons TG. Neonatologists judge the "Baby Doe" regulations. N Engl J Med.1988; 318 :677 –683[Abstract]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This article has been cited by other articles:

				L. M. Kopelman Baby Doe Rules: In Reply Pediatrics, December 1, 2005; 116(6): 1602 - 1603. [Full Text] [PDF]

				I. Hurst Baby Doe Rules Pediatrics, December 1, 2005; 116(6): 1600 - 1601. [Full Text] [PDF]

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Hurst, I. Search for Related Content PubMed PubMed Citation Articles by Hurst, I. Related Collections Premature & Newborn Social Bookmarking                         What's this?