Ethical Decision Making

The “Age of Viability” Debate

Abstract

In the last few decades, medical advancements in the field of neonatology have sparked heavy ethical debate concerning the resuscitation of low gestational age (GA) infants.  As medical treatments, such as respiratory support have improved, the “age of viability” for neonates has shifted towards a younger GA. In general, fetal viability refers to the GA at which critical organs such as the lungs are developed enough to sustain life. Consequently, GA is arguably the primary guiding factor for resuscitation efforts in neonatal patients. However, based on this notion, many health care facilities have developed rigid rules and guidelines based predominantly on GA and neglect other important outcome indicators including fetal birth weight, antenatal corticosteroids, and congenital anomalies. This poses problems such as overtreating microprems and raises ethical concerns including autonomy, beneficence, nonmaleficience, and justice. This paper argues that strict resuscitation guidelines may hinder the ability to make unbiased decisions. Subsequently, infants born at the margins of viability should be assessed individually allowing patient-specific care plans to be developed.