HOW AGGRESSIVE SHOULD TREATMENT BE GIVEN A SICK NEWBORN?

Many times when a child is a few years old and severely disabled, parents begin to wonder whether treatment should have been less aggressive than it was. Given the tremendous uncertainties in outcome, physicians and parents usually choose to treat newborns and preserve life with the hope that the outcome will be a good one. There are clearly exceptions, such as when the baby has a known chromosomal defect (such as trisomy 18), where the poor prognosis is known and where very aggressive treatment may not be used. However, in the majority of cases the information regarding ultimate outcome is not available, and families and physicians do the best they can with he limited information they have. Often the prognosis is based on information from studies of a large number of babies with a similar birth weight. The chance of an individual baby having cerebral palsy or mental retardation(expressed as a percentage) is derived from these studies. Nevertheless, it is impossible to know whether an individual infant will fit into the 70-90 percent group that has a good outcome or the 10-30 percent group with a poor outcome.

The role of the physician is to gather as much information about the child's condition as possible and to convey this information to families along with the best information available about chances for outcome. The role of the family is to help in the decision-making process when there are decisions to be made about further aggressive treatment, though ultimately it is the physician's responsibility to decide what should or should not be done. Most physicians will take into consideration a family's wishes, but physicians cannot give up their legal and moral obligation to do what is best for their patient, nor can a physician withhold treatment without the family's permission. The problem is trying to figure out what is best. At the time the decisions must be made it is often very difficult to know what will ultimately be best. A decision to treat aggressively usually involves the use of sophisticated equipment, although availability of such technology does not mean that it must always be used, and there are clearly times when it is more humane to withhold or withdraw aggressive treatment. These are never easy decisions to make. Clergy, social workers, ethicist, and other health care workers who have come to know the patient and family often help in making a decision about what is best.