Search

This case explores the legal and ethical considerations for pediatricians surrounding gestational carrier pregnancies in the United States. Because of high success rates for assisted reproduction, state laws supporting same-sex adoption and surrogacy, and established legal precedents, gestational carrier pregnancies are increasingly common. The case presented involves a gestational carrier in preterm labor at 30 weeks' gestation with malpositioned twins who declines a cesarean delivery. Three commentaries are presented. The first highlights the importance of understanding the ethical implications of gestational carrier pregnancies in prenatal counseling. The second commentary emphasizes the pregnant person's right to autonomy and bodily integrity, and discusses considerations in surrogacy pregnancies, including the authority to authorize a cesarean delivery, valid informed consent, and decision-making for neonates. The third commentary discusses autonomy, emphasizing the importance of contracts in surrogacy pregnancies, and suggests that, in the case of a conflict between the gestational carrier and the intended parent(s), the gestational carrier's preference should be decisive regarding medical care during pregnancy. These discussions highlight key concepts for ethically informed and family-centered care in gestational carrier pregnancies and deliveries. [ABSTRACT FROM AUTHOR]

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis" by F. M. A. Haward and colleagues. Topics discussed include bias against extremely premature infants, the shortage of other vital resources needed for the safe and comprehensive care of critically ill patients, and inherent bias in triage algorithms.

Ethics and professionalism education has become increasingly recognized as important and incorporated into graduate medical education. However, such education has remained largely unstructured and understudied in neonatology. Neonatal–perinatal fellowship training programs have generally grappled with how best to teach and assess ethics and professionalism knowledge, skills, and behavior in clinical practice, particularly in light of accreditation requirements, milestones, and competencies. This article reviews currently available teaching methods, pedagogy, and resources in medical ethics, professionalism, and communication, as well as assessment strategies and tools, to help medical educators and practicing clinicians ensure trainees achieve and maintain competency. The need for consensus and future research in these domains is also highlighted. [ABSTRACT FROM AUTHOR]

A review of the article “From “Longshot" to “Fantasy": Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail" by Elliott Mark Weiss and Autumn Fiester, which appeared in the periodical “The American Journal of Bioethics " on January 9, 2017, is presented.

Decision-making at extreme prematurity remains ethically and practically challenging and can result in parental and clinician distress. It is vital that clinicians learn the necessary skills integral to counseling and decision-making with families in these situations. A pedagogical approach to teaching counseling should incorporate adult learning theory, emphasize multidisciplinary team in-situ simulation that links to counseling clinicians' daily practice, and includes critical reflection, debriefing, and program assessment. Multiple educational strategies that train clinicians in advanced communication and decision-making offer promising results to optimize antenatal counseling and shared decision-making for families facing possible delivery at extreme prematurity. Continued process evaluation and innovation in these educational domains are needed while also assessing the effect on patient-centered outcomes. [ABSTRACT FROM AUTHOR]

This article explores the ethical concept of "the equivalence thesis" (ET), or the idea that withdrawing and withholding life sustaining treatments are morally equivalent practices, within neonatology. We review the historical origins, theory, and clinical rationale behind ET, and provide an analysis of how ET relates to literature that describes neonatal mode of death and healthcare professional and parent attitudes towards end-of-life care. While ET may serve as an ethical tool to optimize resource allocation in theory, its clinical utility is limited given the complexity of end-of-life care decisions. [ABSTRACT FROM AUTHOR]

The article discusses the impact of computer on wheels (COWs) on physician-patient-parent relationship. Topics include how COWs improve patient communication, the benefits of effective communication to both physicians and patients and modules aimed to teach and improve communication skills. Also included are the problems of COWs that may impede good communication.

Wait, what? I've been fired?' I repeated, in the middle of morning rounds in the neonatal intensive care unit. Finally, the nurse who was taking care of our patient, Angela, responded, 'Her parents fired you last night. They've already called Patient Relations. They want a new doctor.' My heart sank. Only days into my block of service time as the attending physician in the NICU and I was fired, axed, canned, rejected by a family. How could this have happened? On my first day of service, I had introduced myself to Angela's parents, and I had then met with them daily to review results and the plan and to answer their questions. I thought we had connected well. I thought I had done everything right. I thought they trusted me to care for their daughter. [ABSTRACT FROM AUTHOR]

With advancing rank in medical training comes increased academic and clinical responsibility, including education and supervision of trainees and junior staff. When I became a senior postdoctoral fellow sub-specializing in neonatology, I assumed the role of co-attending in the neonatal intensive care unit. At that point in my training, I felt well prepared for the challenging task. I would be in charge, make decisions independently with the team, and supervise, as well as teach, the junior fellows, residents, and practitioners. In short, I would assume full responsibility for the care of the patients, their families, and the medical team. My mentor, an experienced attending, would discuss every patient with me each day, but would otherwise stand in the shadows, available for help and guidance when needed. On the very first day, one of the smaller premature babies on our service started having difficulty breathing, and it was soon clear that she would need to have her endotracheal tube reinserted. [ABSTRACT FROM AUTHOR]

The author discusses some of the different views with regards to pregnancy, as disrupting the physician-patient relationship especially in case of pregnant physicians dealing with a mother who has just lost her newborn child. The main challenge is that exactly when a personal touch or story crosses professional boundaries and becomes disruptive is hard to say. The author hopes to improve communication with the families of her patients by addressing issues as and when they come up.

1. Define advance care planning. 2. Describe parentally reported end-of-life care outcomes for infants in the neonatal intensive care unit. To evaluate bereaved parental preferences, experiences, and end-of-life (EOL) outcomes around advance care planning (ACP) in the neonatal intensive care unit (NICU). A single-center, cross-sectional, mixed-methods survey study of bereaved parents who experienced the death of a child in the Boston Children's Hospital NICU between 2010–2021. Logistic regression, Pearson's exact test, and Wilcoxin rank sum tests were used to evaluate the relationship between ACP and parent-reported EOL outcomes. Parental perspectives on EOL outcomes (ie, decisional regret, goal concordant care, preparedness) were elicited through open-ended questions and qualitative content was analyzed through inductive coding. 40/146 (27%) of eligible parents responded to our survey. Most parents (82%) reported participating in ACP conversations and preferred these conversations early in their child's illness course with members of the NICU, subspecialist, or the palliative care teams. There was a significant association between ACP and improved EOL care processes and satisfaction with care related to communication. Parents who endorsed ACP were also more likely to report goal concordant care and higher levels of perceived shared decision making. Qualitatively, misaligned expectations and communication emerged as themes for goal-concordant care, while logistical aspects, infant symptoms, impact on parents, and degrees of preparedness emerged as themes for parental preparedness for infant EOL, and re-evaluating supports emerged as a theme that for parental decisional regret. The majority of parents in this study participated in and valued ACP conversations. Participation in ACP was associated with improvement in some EOL outcomes, suggesting a further role for ACP in the NICU. Similarities and differences exist between how parents characterize goal concordant care, preparedness for EOL, and decisional regret. [ABSTRACT FROM AUTHOR]