Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard


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Abstract

OBJECTIVE:The objective of this study is to determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS).STUDY DESIGN:Members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life-sustaining therapy (LST).RESULTS:Neonatologists' median response supported an infant-specific BIS conceptualization that linked the infant's and family's interests. They did not support allowing limitations on the family's obligations. Ethicists' supported a conceptualization that linked the infant's and family's interests and limitations on the family's obligations, a less infant-specific conceptualization. Ethicists were less or equally likely to agree with forgoing LST in seven of eight cases.CONCLUSIONS:Ethicists endorsed a conceptualization of the BIS that includes the effects on the family and rejected an infantspecific one. Neonatologists split between these two and rejected limiting the family's obligations. Critical appraisal of the BIS is needed in neonatal ethics.

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