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November 1991

Treatment Withdrawal in Neonates

Author Affiliations

University of Alberta Hospitals 2C300 Walter V. Mackenzie Health Sciences Center Edmonton, Alberta, Canada T6G 2R7

Am J Dis Child. 1991;145(11):1223-1224. doi:10.1001/archpedi.1991.02160110013006

Sir.—The recent article by Young and Stevenson1 describes the Stanford "individualized prognostic strategy" approach to aggressive support in the neonatal intensive care unit as the exception to the American norm. If this statement is indeed valid, it is a sad reflection on neonatal intensive care in the United States. The authors ask why there is such difficulty in stopping aggressive therapy, and suggest fear of litigation as a likely cause. Although such decision making is in an area of uncertainty, this should not prevent a decision from being reached. Physicians in training, particularly in acute care areas, must be taught that good clinical decisions cannot always be made with certainty. Clinical judgments are made in the best interest of the patient without any guarantee of certainty. The physician's responsibility must be to inform the family of the risks and benefits of treatment and to help formulate a plan