Ethical issues in neonatal perinatal medicine (NPM) in India: A survey. 158

Abstract

Aim: To elicit the perceptions of pediatricians with neonatal interest on ethical issues in NPM in India. Methods: A convenience sample survey was conducted. The survey had seventeen questions to be completed anonymously by the respondents. Sixty-five of 70 (93%) attending a national neonatal meeting and 38 of 105 (36%) selected randomly as every twelveth member of the National Neonatology Forum Members, completed the survey (n=103). The data were tabulated from the completed surveys. Results: 1) Common ethical dilemmas include severe birth asphyxia, congenital malformations, extreme prematurity, low birth weight, terminally ill neonates on life support and parents unable to afford care. 2) Seventy-three percent reported having experienced ethical dilemma(s). Thirty-eight percent of respondents admitted having stopped treatment of extremely sick neonates. Ten percent do not resuscitate neonates weighing less than 750 gm, while 34% do not resuscitate neonates with major malformations of brain and spine. 3) Their decisions were based on prognosis of the infant(83.5%), weight of the infant (49.5%), parental desire (42.7%), and socio-economic status of parents (39.8%). None stated that baby's gender was a consideration. 4) Over two-thirds (68.9%) of respondents regularly involved parents in decision making. 5) Twenty-one percent stated that their hospitals had an Ethics Committee.Conclusions: This first limited survey of its kind on ethical issues in neonatal-perinatal care from India documents the ethical problems faced by Indian pediatricians. Quality of life weighed heavily in decision making. Parental autonomy seems to be preserved. Among pediatricians, female gender did not appear to be a factor in decision making. Hospitals in India are beginning to form Ethics Committees to address ethical dilemmas.