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Article
October 9, 1987

The Consequences of UncertaintyAn Empirical Approach to Medical Decision Making in Neonatal Intensive Care

Author Affiliations

From the Department of Pediatrics, Stanford (Calif) University School of Medicine. Dr Fischer is a fellow in Neonatology.

From the Department of Pediatrics, Stanford (Calif) University School of Medicine. Dr Fischer is a fellow in Neonatology.

JAMA. 1987;258(14):1929-1931. doi:10.1001/jama.1987.03400140091031
Abstract

BEFORE being struck down, the "Baby Doe" rule generated intense debate among those individuals who were interested in the ethical underpinnings of neonatal intensive care.1 The enormity of the gap between the attempt to regulate physician behavior and the reality in which such regulation was to occur was reflected in the implicit anonymity of the designation, Baby Doe. The treatment of many different conditions affecting individual patients could not possibly be regulated by a few general directives based on the anticipated outcome for the entire group. The ability to predict outcomes for individual, severely disabled infants is limited, even with precise knowledge of the infant's condition at birth.

To understand the difficulty in making decisions regarding the care of extremely premature neonates, it is imperative to understand the complex professional charge of the physician. As set forth in the Hippocratic tradition, the charge has two parts. The first is

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