Terminal medical care for neonates with life-threatening prognosis : Guidelines for ethical and medical decision-making in Yodogawa Christian Hospital.

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  • 赤ちゃんの看取りの医療 : 淀川キリスト教病院における倫理的、医学的意志決定のガイドライン <特別論文>
  • 赤ちゃんの看取りの医療--淀川キリスト教病院における倫理的,医学的意志決定のガイドライン
  • アカチャン ノ ミトリ ノ イリョウ ヨドガワ キリストキョウ ビョウイン ニ オケル リンリテキ イガクテキ イシ ケッテイ ノ ガイドライン

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Abstract

Recent rapid advances in medical technology, such as mechanical ventilation and other changing technology, make it possible that many patients at in life-threatening conditions can survive without any sequelae. On the other hand, it also becomes possible that the lives of terminally-ill patients can be artificially prolonged by mechanical measures. This fact is not an exceptional event in the field of neonatal medicine. In recent years ethical problems in NICU have come into the forefront with such searching questions raised as "how small is too small?" in terms of "excessive treatment" or "too little treatment". In this paper, the ethical ground for decision-making is described in regard both to the withholding of treatment or the withdrawing of "excessive treatment" for neonates with life-threatening circumstances. Also introduced are the guidelines for ethical and medical decision-making which have been approved by the ethical committee of our hospital, The procedure for this decision-making in such cases is also explained. These ethical problems require more sophisticated humane skills, rather than technical skills alone. The ethical decision-making is based on a scientific perspective of the prognosis and the "best interests" of the infant. It is vital to consider as a team, "What is the best treatment for this infant, if he or she were my lovely baby or if I were him or her". If the parents' wishes and the informed choice of palliative care are ethically acceptable, they should be professionally supported by the team. For neonates in a clinical situation with life-threatening conditions, further developments and research of the best medical care should be carefully investigated.

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