par Simeoni, Umberto;Haumont, Dominique 
Référence Ethics, Medicine and Public Health, 1, 2, page (173-178)
Publication Publié, 2015-04
Référence Ethics, Medicine and Public Health, 1, 2, page (173-178)
Publication Publié, 2015-04
Article révisé par les pairs
| Résumé : | Births at the limit of viability are extremely complex, emblematic situations in the debate on medical futility, the "senseless obstinacy" as mentioned in the French law on end of life. The context of extreme preterm birth is highly specific, due to multiple natural, medical, psychological and socio-economical factors. It led in the past to decision-making processes based on simplistic, collective criteria, such as birth weight or gestational age thresholds, that were considered essential safeguards to avoid excess medical intervention and assist in medical decision-making. Currently available scientific information from population-based studies of patients follow-up, together with a renewed ethical reflection, aware of the biases induced by the symbolic context, are changing the views of many health care professionals and ethicists. Both lead today to the back to basics conclusion that the respect of the fundamental, individual rights of every infant, born extremely premature or not, and the patient's best interest do apply in this field like in others fields of medicine through individualized, not category-based medical decisions. Such principles should especially guide medical decisions involving antenatal interventions around the limit of viability, which constitute the most complex dilemmas. |
