Seminars in perinatology
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The Texas Advance Directives Act was first passed in 1999 to help resolve conflicts between families and physicians when disagreements exist over continuing or halting treatments of patients. When the physician feels that continued treatment is ethically or morally unjustified and seeks to end life support for a patient against the wishes of the family, it establishes a specific path that must be followed to afford legal protection to the physician and institution. Its proponents believe that it reduces morally unjustifiable treatment of terminal patients, while its opponents argue that it places too much power in the hands of physicians and institutions. This review analyzes both sides of the argument, gives 2 examples of its application, and concludes that it is a good model but requires modification to correct some flaws.
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It is widely believed in neonatology and obstetrics that there are situations in which it is inappropriate to attempt newborn resuscitation, and other times when newborn resuscitation is obligatory despite parental refusal. In each case, an ethical justification for the decision needs to be identified. ⋯ It specifically addresses the issue of extreme prematurity, including an analysis of current recommendations, the data, relevant rights of patient and parents, and a discussion of the relative merits of withholding resuscitation vs providing resuscitation and possibly withdrawing intensive care later. In addition to extreme prematurity, the considerations presented are also relevant to a wider spectrum of newborn problems, including Trisomy 13, Trisomy 18, and severe congenital anomalies.