J Med Ethics. 2016 Mar 17. pii: medethics-2015-102941. doi: 10.1136/medethics-2015-102941. [Epub ahead of print]

In what circumstances will a neonatologist decide a patient is not a resuscitation candidate?

Murray PD1, Esserman D2, Mercurio MR3.

Author information

• 1Division of Newborn Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA.
• 2Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.
• 3Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA Program for Biomedical Ethics, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVE:

The purpose of this study was to determine the opinions of practising neonatologists regarding the ethical permissibility of unilateral Do Not Attempt Resuscitation (DNAR) decisions in the neonatal intensive care unit.

STUDY DESIGN:

An anonymous survey regarding the permissibility of unilateral DNAR orders for three clinical vignettes was sent to members of the American Academy of Pediatrics Section of Perinatal Medicine.

RESULTS:

There were 490 out of a possible 3000 respondents (16%). A majority (76%) responded that a unilateral DNAR decision would be permissible in cases for which survival was felt to be impossible. A minority (25%) responded 'yes' when asked if a unilateral DNAR order would be permissible based solely on neurological prognosis.

CONCLUSIONS:

A majority of neonatologists believed unilateral DNAR decisions are ethically permissible if survival is felt to be impossible, but not permissible based solely on poor neurological prognosis. This has significant implications for clinical care.