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Massachusetts Medical Society




Disputes between physicians and patients over medical care have tended toward resolution in both the courts and ethics committees, with each of these bodies ultimately deciding that the informed, competent patient must be the final decision maker. Parents, too, have the authority to make medical decisions for their children, but these decisions can be challenged if physicians do not believe they are medically reasonable. One bioethical issue, however, is as intractable today as it was 30 years ago, when it began to be publicly discussed: the extent of parental authority to refuse life-sustaining medical treatment for an extremely premature infant. Who decides for the newborn, and on what basis, when there is conflict between the parents and the physician? In his 1984 book on this topic, Robert Weir put it simply and accurately: “Without doubt, decision making is difficult in cases involving birth-defective newborns.” This remains true today, with virtually no change in either the substantive criteria to apply to the decision or the procedures to follow, and decision making is even more complex with extremely preterm infants.


From The New England Journal of Medicine, George J. Annas, Extremely Preterm Birth and Parental Authority to Refuse Treatment: The Case of Sidney Miller, Volume 351, Page 2118 Copyright ©(2004) Massachusetts Medical Society. Reprinted with permission.

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