Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne.
Publication Title
Journal of perinatology : official journal of the California Perinatal Association
Document Type
Article
Publication Date
4-1-2018
Abstract
Most extremely premature infants die in the intensive care unit or suffer significant neurologic impairment. Many therapies result in unhealthy consequences, and the emotional and financial turmoil for families warrant reappraisal of our motives. Shared decision-making and informed consent in preference-sensitive conditions imply the family: (a) understands the medical problem, (b) grasps the risks and benefits of each therapy, (c) has the opportunity to ask questions and reflect upon options, (d) knows their values and preferences are understood, and (e) accepts or declines therapies without judgment or penalty. Mandatory resuscitation of premature infants or inflexible palliative comfort care policies are inconsistent with the principles of informed consent and shared decision-making. Physicians should emulate the Greek ideal of sophrosyne-virtue inherent to balance, reasoned limits, freedom but restraint, and humility. Informed choice is fundamental to liberty; evidence-based periviability guidelines and decision aids bolstered by structured informed consent ensure process integrity.
Area of Special Interest
Women & Children
Specialty/Research Institute
Perinatology/Neonatology
Specialty/Research Institute
Obstetrics & Gynecology
Specialty/Research Institute
Biomedical Ethics
