Best Interest Assessment Flaws

Best Interest Assessment Flaws

Bellieni CV and Buonocore G. Flaws in the assessment of the best interests of the newborn. Acta Paediatr. 2009 Apr;98(4):613-7. Epub 2009 Jan 22. Abstract | HTML | PDF

We examined the literature on ethical decisions regarding neonates, to assess whether personal beliefs and prejudices influence end-of-life decisions taken by caregivers. Studies show that religion and familiarity with disability influence caregivers' decisions, whereas the influx of already being a parent, age, sex and professional experience is controverse. Caregivers' attitudes towards end-of-life decisions are also affected by personal concerns about litigation, prejudices and their view of disability. The concept of 'poor quality of life' is widely used as a reference in end-of-life decisions, but this can be interpreted differently, leaving room for a wide range of personal viewpoints. In most cases, parents' opinions are considered important and are sometimes the main determinant in decision making. However, it is unclear whether parents' decisions are based on their own wishes or on the best interests of the newborn.

Conclusion: In neonatal end-of-life decisions, patients may not receive cures based only on their best interests.

Comments: This is an important and a controversial issue. I think that end-of-life decisions are frequently made on basis of the patient’s condition; and, of course, parent wishes are also considered. There needs to be a lot of debate to define the correct meaning of end-of-life care decisions. I agree that sometimes the decision is not in the very best interest of the patient. JMK.

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