ETHICAL ISSUES RAISED BY INTENSIVE-CARE IN THE NEWBORNS

At birth, around 3 % of newborns are in vital distress. Due to development of intensive care, most of them can now be saved. However some survivors will suffer very severe neurodevelopmental sequelae. Should all newborns be rescued ? Should we allow to die any selected babies for whom the prognosis is very poor ? How are these questions argued within the caring team ? A process for addressing these ethical issues in practice has been set up, based upon an analysis of the relationship between the participants involved - i.e. the baby, the parents, the caring team - and on a prolonged experience. In short, the following land marks should be respected : any newborn, whatever his initial condition, must be taken in charge as for any other diseased human being ; in case of very poor prognosis, fully assessed by all the means at disposal, prolonging intensive care has no more sense and the baby's death can be a medical option ; the ultimate decision relies upon the medical team ; the parents have to be well informed of the severity of the medical situation, but must be protected against the feeling of their direct responsability for their baby's death. Putting these principles in practice is difficult : physicians as well as nurses have to closely work out together.