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June 2, 1999

Decisions Regarding Treatment of Seriously Ill Newborns

Author Affiliations

Author Affiliation: Department of Pediatrics and Program in Medical Ethics, University of Wisconsin Medical School, Madison.

JAMA. 1999;281(21):2041-2043. doi:10.1001/jama.281.21.2041

There has been a remarkable transformation during the past 15 years in the process and substance of decisions regarding medical treatment of seriously ill and handicapped newborns. For thousands of years, parents exercised virtual ownership over their infants.1 Infanticide was common in Western Europe until late in the 19th Century.2,3 In the United States during the 1970s, standard medical treatment for curable disorders was commonly withheld from infants with Down syndrome, a practice that was supported by two thirds of pediatricians.4,5 In 1983, a major medical center reported that standard treatment was withheld from more than half of a cohort of infants referred with spina bifida.6 These decisions were often driven by directive counseling by the infants' physician, with or without the consent of the parents. Courts were generally supportive of the rights of biologic parents to make such decisions, even when it was implausible that withholding treatment was in the child's interests.7

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