Shared decision-making, value pluralism and the zone of parental discretion.

"Good ethics start with good facts" wrote John Lantos and William Meadow in a 2009 editorial addressing periviability controversies - debates that continue to generate lively discussion amongst neonatologists, obstetricians, ethicists, and families (1). How do we best promote shared decision making with pregnant women who, through no fault of their own, might deliver an extremely premature infant? Unfortunately, the recent "A Different View" in this journal by Dr. Patrick Marmion regarding periviability issues in general, and specifically our shared decision making model at Providence St. Vincent Medical Center (PSVMC) in Portland, OR, is decidedly short on facts and is regrettably inflammatory (2). We appreciate the opportunity to respectfully clarify our bioethical foundation and periviability dialogue framework with the hope of promoting reasoned dialogue and understanding. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]