Specific advocate guidelines are needed for the protection of children in state custody who are potential research subjects in trials that would expose them to greater-than-minimal risk but also hold the prospect of direct benefit.
Frank A. Chervenak, MD and Laurence B. McCullough, PhD
Clinical facts and physicians’ ethical obligations are critical in resolving disagreements between parents and physicians about resuscitation of an extremely premature infant.
Nonlegal, judicial, and statutory courses of action are available to patient surrogates and physicians who cannot agree on withdrawal of life-sustaining treatment.
The current Medicare operation—reimbursing medical goods and services to a growing number of people without basing the reimbursement benefit on the actual cost of the services—is unsustainable, but there are some possible remedies.
Physicians should fully understand the ethical principles and professional standards involved in making decisions for the treatment of impaired newborns.
Physicians need to help surrogate decision makers to make treatment and end-of-life decisions for those with severe neurological damage by proving a realistic prognosis and maintain strong lines of communication.