The greatest pressure to resuscitate the extremely low-birth-weight infant often results from successful marketing efforts that lead families to expect that their premature infants will be cute and healthy.
Physicians new to a case might object to an established care plan. Practice variation, clinical momentum, and how value is assigned by different parties to acute care and comfort measures can each contribute to conflict in these cases.
AMA J Ethics. 2018;20(8):E699-707. doi:
10.1001/amajethics.2018.699.
The case of Johnson v Kokemoor illuminates the conflict between patients’ right to informed consent and clinicians’ need to learn through practice, a conflict that possibly could be resolved through greater transparency about clinicians’ experience or experience-dependent medical fees.
Using evidence-based medical guidelines in courts will require confronting legal professionals' lack of training in assessing scientific evidence, the limitations of available evidence, and fundamental distinctions between the meaning of evidence in medicine and law.
Forcing parents to participate in treatment is unlikely to succeed. Seeking to optimize the therapeutic alliance between family and pediatrician is more likely to achieve the desired outcome—the child’s short- and long-term well-being.