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ONE: Decision Making, Rationing, and the Imperiled Neonate

by Jared Howes

“Tied to machines that make me be. . . I cannot live. I cannot die.”[1]

         When James Hetfield and Lars Ulrich of the American metal band Metallica penned the hit song “One”, in 1988, they probably were not thinking about bioethics. Demonstrating the horrors of warfare through the terrible quality of life a maimed soldier experiences post lifesaving treatment, they unwittingly tapped into a major ethical issue facing the medical community; while medical technique and technology had made tremendous progress in recent decades, medical ethics had lagged behind resulting in a gap.[2] The use of advance lifesaving technology may create, for the first time, situations where a patient is either suspended between life and death, or is left with heavy physical or mental impairment.[3] Many see the erosion of patient’s quality of life as such a burden that it would be better to euthanize them than allow for such a cruel and dreadful existence to persist. Compounding the problem are cases involving imperiled newborns who receive lifesaving treatment in the neonatal intensive care unit (NICU). This compounding is influenced by the emotional reality of the patient being a newborn who hasn’t yet had a chance to live life, form value systems, or ponder advance directives; and the clinical reality that such patients, lacking both capacity and legal competency, must rely on surrogates to determine their fate.

     There has been much debate within the field of bioethics on what factors should be used in determining whether an imperiled infant will or will not receive lifesaving care. Two polar views have emerged. On one side is vitalism, which demands everything be done to save the life of an imperiled infant, and on the other side a libertarian autonomy, leaving the decision solely up to the parents.[4] Other theories lie on a spectrum between these two extremes. In this essay I will answer three questions: At what level should decisions of healthcare rationing be made? What criteria should be employed for determining the treatment of an imperiled newborn? And who ultimately decides the fate of an imperiled newborn? There exists a diverse corpus of literature about these questions, and certainly the sheer amount is beyond the scope of this essay. Therefore, I have chosen two main ethical theories to form the basis of my argument; quality of life models and personalist morality. In addition to presenting differing scholars from within each theory, I will borrow heavily from the tradition of Christian discernment to inform my conclusion. I do not intend my choice of included models or specific authors as a rejection of other theories but merely a practical limitation.[5]       

Click here to read Jared's entire paper.    

"The use of advance lifesaving technology  may create, for the first time, situations where a patient is either suspended between life and death, or is left with heavy physical or mental impairment."
Relevant Content

Read Arras's "Toward an Ethic of Ambiguity" on The Hastings Center Report...[read more]

Click here to preview Richard C. Sparks' "To Treat or Not to Treat: Bioethics and the Handicapped Newborn"

Official Music Video: Metallica "One"

About the author...

Jared Howes is in his first year of the Bioethics Masters program at LMU. He is currently working on a paper concerning the ethics of neuromarketing in healthcare settings. He is also researching intra-Catholic conflicts within specific countries for Fr. Thomas Rausch of LMU's Theology department. 

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