The Role of Parental Consent in the Medical Care of Extremely Preterm Babies

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Paweł Łuków


The paper analyses the application of the best interest standard in the medical care of extremely preterm babies. It proposes that as long as the parents base their decision on a well-founded medical opinion regarding the neonate’s diagnosis and prognosis and are not victims of superstition or prejudice, medical professionals are obligated to respect the parents’ informed consent, even if the professionals disagree with the parents’ opinion. In their assessments of the neonate’s interest, medical professionals can be primarily guided by their judgment regarding its diagnosis and prognosis. By contrast, the personal involvement of the parents in the decision-making process, their values and the family-specific context of the infant’s possible future makes their opinion regarding the infant’s interests significantly more convincing than the opinions of other persons involved.


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Łuków, Paweł. 2020. “The Role of Parental Consent in the Medical Care of Extremely Preterm Babies”. Diametros 17 (63):40-55.
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Anspach R.R. (1993), Deciding Who Lives: Fateful Choices in the Intensive-Care Nursery, University of California Press, Berkeley.

Archard D. (2003), Children, Family, and the State, Ashgate, Aldershot, Hants, Burlington, VT.

Bourillon A., Dehan M., Beaufils F., Fournier E. (1986), Incidence des facteurs d’environnement dans la décision éthique en réanimation pédiatrique, „Archives Françaises de Pédiatrie” 43 (suppl. 1): 563–568.

Brosig C.L., Pierucci R.L., Kupst M.J., Leuthner S.R. (2007), Infant End-of-Life Care: The Parents’ Perspective, „Journal of Perinatology” 27 (8): 510–516.

Buchanan A.E., Brock D.W. (1989), Deciding for Others: The Ethics of Surrogate Decision Making, Cambridge University Press, New York.

Byrne S., Szyld E., Kattwinkel J. (2008), The Ethics of Delivery-Room Resuscitation, „Seminars in Fetal and Neonatal Medicine” 13 (6): 440–447.

Code de la santé publique. Version consolidée au 12 mars 2018.

Cuttini M., Casotto V., Orzalesi M., Euronic Study Group (2006), Ethical Issues in Neonatal Intensive Care and Physicians’ Practices: A European Perspective, „Acta Paediatrica Supplement” 95 (452): 42–46.

DeGrazia D. (1995), Value Theory and the Best Interests Standard, „Bioethics” 9 (1): 50–61.

Dehan M. (1997), L’éthique et sa pratique en neonatologie, [w:] Philosophie, éthique et droit de la médecine, J.-F. Mattéi, B. Feuillet-Le Mintier, D. Folscheid (red.), Presses Universitaires de France, Paris: 375–390.

Diekema D.S., Mercurio M.R., Adam M.B. (2011), Clinical Ethics in Pediatrics: A Case-Based Textbook, Cambridge University Press, Cambridge.

Duff R.S. (1987), “Close-Up” Versus “Distant” Ethics: Deciding the Care of Infants with Poor Prognosis, „Seminars in Perinatology” 11 (3): 244–253.

Elliston S. (2007), Best Interests of the Child in Healthcare (1st ed.), Routledge-Cavendish, New York.

Elster J. (1987), Solomonic Judgments: Against the Best Interest of the Child, „University of Chicago Law Review” 54 (1): 1–45.

Herring J. (2005), Farewell Welfare?, „Journal of Social Welfare and Family Law” 27 (2): 159–171.

K.k. Ustawa z dnia 6 czerwca 1997 r. – Kodeks karny. Dz.U. 1997 nr 88 poz. 553 z późn. zm.

K.r.o. Ustawa z dnia 25 lutego 1964 r. – Kodeks rodzinny i opiekuńczy, Dz.U. 1964 nr 9 poz. 59 z późn. zm.

KEL (2004), Kodeks etyki lekarskiej: tekst jednolity z dnia 2 stycznia 2004 r., zawierający zmiany uchwalone w dniu 20 września 2003 r. przez Nadzwyczajny VII Krajowy Zjazd Lekarzy (Biuletyn NRL 2004, nr 1, poz. 84), Naczelna Izba Lekarska, Warszawa.

Kipnis K. (2007), Harm and Uncertainty In Newborn Intensive Care, „Theoretical Medicine and Bioethics” 28 (5): 393–412.

Kopelman L.M. (1997), The Best-Interests Standard as Threshold, Ideal, and Standard of Reasonableness, „The Journal of Medicine and Philosophy” 22 (3): 271–289.

Kopelman L.M., Kopelman A.E. (2007), Using a New Analysis of the Best Interests Standard to Address Cultural Disputes: Whose Data, Which Values?, „Theoretical Medicine and Bioethics” 28 (5): 373–391.

Lantos J.D., Meadow W.L. (2006), Neonatal Bioethics: The Moral Challenges of Medical Innovation, Johns Hopkins University Press, Baltimore.

McHaffie H.E., Lyon A.J., Hume R. (2001), Deciding on Treatment Limitation for Neonates: The Parents’ Perspective, „The European Journal of Pediatrics” 160 (6): 339–344.

Mnookin R.H. (1975), Child-Custody Adjudication: Judicial Functions in the Face of Indeterminacy, „Law and Contemporary Problems” 39 (Summer): 226–293.

Nguyen T.A.P., Ho L.Y. (2013), Review on Neonatal End-of-Life Decision-Making: Medical Authority or Parental Autonomy?, „Proceedings of Singapore Healthcare” 22 (2): 140–145.

Nuffield Council on Bioethics (2006), Critical Care Decisions in Fetal and Neonatal Medicine: Ethical Issues, URL = [dostęp 24.02.2020].

Ong S.Y. (2013), The Ethics of Neonatal Resuscitation, „Proceedings of Singapore Healthcare” 22 (2): 99–102.

Orfali K. (2004), Parental Role in Medical Decision-Making: Fact or Fiction? A Comparative Study of Ethical Dilemmas in French and American Neonatal Intensive Care Units, „Social Science & Medicine” 58 (10): 2009–2022.

Orzalesi M.M., Cuttini M. (2011), Ethical Issues in Neonatal Intensive Care, „Annali dell’Istituto Superiore di Sanità” 47 (3): 273–277.

Polskie Towarzystwo Neonatologiczne (2017), Zasady postępowania w neonatologii przy podejmowaniu decyzji o objęciu opieką paliatywną uwzględniające racje etyczne, wydanie II (2017) zaktualizowane i uzupełnione, [w:] Standardy opieki medycznej nad noworodkiem w Polsce, M.K. Borszewska-Kornacka (red.), Polskie Towarzystwo Neonatologiczne, Warszawa.

Rhodes R., Holzman I.R. (2014), Is the Best Interest Standard Good for Pediatrics, „Pediatrics” 134 (suppl 2): 121–129.

Rutkowska M. (red.) (2011), Noworodek urodzony na granicy możliwości przeżycia. Część druga: Rekomendacje dotyczące postępowania z matką oraz noworodkiem urodzonym na granicy możliwości przeżycia z uwzględnieniem aspektów etycznych, „Medycyna Wieku Rozwojowego” 2/15 (3): 356–367.

Scanlon T. (1998), What We Owe to Each Other, Belknap Press of Harvard University Press, Cambridge, Mass.

Shah S. (2013), Does Research with Children Violate the Best Interests Standard? An Empirical and Conceptual Analysis, „Northwestern Journal of Law & Social Policy” 8 (2): 121–173.

Shaw A. (1977), Defining the Quality of Life: A Formula Without Numbers, „Hastings Center Report” 7 (5): 11.

Sinclair J.C., Torrance G.W. (1995), The Use of Epidemiological Data for Prognostication and Decision Making, [w:] Ethics and Perinatology, A. Goldworth, W. Silverman, D.K. Stevenson, E.W.D. Young (red.), Oxford University Press, New York: 120–145.

Szewczyk K. (2010), Decyzje krytyczne w neonatologii i standardy ich podejmowania, „Diametros” 26: 96–135.

Szewczyk K. (2012), Czy rodzice powinni mieć prawo do decydowania o życiu i śmierci krytycznie chorych noworodków?, „Diametros” 34: 154–178.

U.p.p. Ustawa z dnia 6 listopada 2008 r. o prawach pacjenta i Rzeczniku Praw Pacjenta, tekst jedn. Dz.U. 2009 nr 52 poz. 417 z późn. zm.

U.z.l. Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty, tekst jedn. Dz.U. 1997 nr 28 poz. 152 z późn. zm.

President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983), Deciding to Forego Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: For sale by the Supt. of Docs., U.S. G.P.O., Washington, DC.

Weir M., Evans M., Coughlin K. (2011), Ethical Decision Making in the Resuscitation of Extremely Premature Infants: The Health Care Professional’s Perspective, „Journal of Obstetrics and Gynaecology Canada” 33 (1): 49–56.

Whitney S.N. (2005), The Extremely Premature Infant at the Crossroads: Ethical and Legal Considerations, [w:] Ethical Dilemmas in Pediatrics: Cases and Commentaries, L.R. Frankel, A. Goldworth, M.V. Rorty, W.A. Silverman (red.), Cambridge University Press, Cambridge, New York.