THE INFANT'S BEST INTEREST – No justice for premies

Aims: A Canadian questionaire (1,2) showed that the best interest standard is not followed for neonatal resuscitation decision. Is a similar devaluation of neonates also present in Germany? Methods: An anonymous survey (based on the Canadian study) at a German medical school depicting 8 fictitious scenarios requiring resuscitation: a preterm, a term infant, a 2-month old and a woman with polytrauma with the same outcome, a 7-year and an 80-year old previously impaired, a girl and a young man with very low survival chance. Results: 129 physicians and 528 students responded. Most felt that it was in the best interest of the 2-month and the 7-year old (>92%) to be resuscitated, followed by the preterm (89%), the polytrauma (87%), the term infant (85%). German respondents valued the best interest of the preterm infant higher than the Canadian study (89 vs. 69%). Despite that the majority of respondents thought resuscitation was in the preterm and the term infant best interest, >60% would follow the parents request for non-resuscitation, compared to 41%, 35% for the 2 month and the 50 year old with similar outcomes and 36% for the multiple impaired child. Conclusions: In opposite of the great willingness to resuscitate the preterm and the term infant and the good chance of non-impaired survival, the families refusal will be readily accepted, even if resuscitation was thought to be in the babys best interest. This was not the case with the older patients with same survival rates and suggests, that parental interest is valued above the interest of infants. Thus, the best interest standard is not followed for preterms, neither by physicians, nor by students, neither in Canada, nor in Germany.

Literatur: 1. Janvier A, Leblanc I, Barrington KJ 2008 Nobody likes premies: the relative value of patients' lives. J Perinatol 28:821-826 2. Janvier A, Leblanc I, Barrington KJ 2008 The Best-Interest Standard Is Not Applied for Neonatal Resuscitation Decisions. Pediatrics 121:963-969

decision - resuscitation - viability