Neonatal Neuroethics

Providing care in the perinatal period brings medical practice to the essence of what it means to be human: fertility, birth, death, dignity, personhood, parenthood, and beyond. Such a shifting technological and moral landscape necessitates practitioners to develop an adaptable ethical framework to address complex, emotionally charged, value-laden decisions. As the border of viability is pushed earlier in gestational life and we improve treatment of conditions that were once considered untreatable, areas for ethical inquiry and potential moral distress grow. Our ethical examinations of such advances often lag, evolving as the shortcomings of those leaps become apparent. Projected neurologic function often lies at the heart of ethical questions that emerge in the neonatal period. Despite rigorous efforts in research, reliable, evidence-based guidance is lacking. We must investigate many elements of the decision-making process concerning medical practitioners, families, and the courts. We must balance the rights of the patient and surrogate decision-makers, the duties of the physician and care team, legal precedent, and questions revolving around quality and quantity of life. Recent controversies highlight the challenge of communicating with desperate parents, the delicate balance involved in respecting family preferences today, and research that yields valuable evidence for superior care tomorrow.