The Moral Challenges of Medical Innovation

Neonatal intensive care has been one of the most morally controversial areas of medicine during the past thirty years. This study examines the interconnected development of four key aspects of neonatal intensive care: medical advances, ethical analysis, legal scrutiny, and econometric evaluation. The authors assert that a dramatic shift in societal attitudes toward newborns and their medical care was a stimulus for and then a result of developments in the medical care of newborns. They divide their analysis into three eras of neonatal intensive care. The first, characterized by the rapid advance of medical technology from the late 1960s to the Baby Doe case of 1982, established neonatal care as a legitimate specialty of medical care, separate from the rest of pediatrics and medicine. During this era, legal scholars and moral philosophers debated the relative importance of parental autonomy, clinical prognosis, and children's rights. The second era, beginning with the Baby Doe case (a legal battle that spurred legislation mandating that infants with debilitating birth defects be treated unless the attending physician deems efforts to prolong life ''futile''), stimulated efforts to establish a consistent federal standard on neonatal care decisions and raised important moral questions concerning the meaning of ''futility'' and of ''inhumane'' treatment. In the third era, a consistent set of decision-making criteria and policies was established. These policies were the result of the synergy and harmonization of newly agreed upon ethical principles and newly discovered epidemiological characteristics of neonatal care. Tracing the field's recent history, notable advances, and considerable challenges yet to be faced, the authors present neonatal bioethics as a paradigm of complex conversation among physicians, philosophers, policy makers, judges, and legislators which has led to responsible societal oversight of a controversial medical innovation.Reviews''With neonatology as a case study, they take us well beyond the confines of this new field to examine broader issues in medical innovation . . . Insightful and thought provoking.''—John W. Sparks, M.D. , New England Journal of Medicine''An engaging history and philosophical analysis . . . A clearly written reflection that has broad implications and insights for all of medicine.''—Jon F. Watchko, JAMA''Recounting the concise history of modern neonatology and the evolution of its attendant ethical questions, John Lantos—a recognized ethicist and pediatrician—and William Meadow—an experienced neonatologist—give us a lens through which many in neonatology may engage in a self-examination of their own history, practice, and specialty. But more than a historical recounting, this book brings the reader to an awareness of the integral relationships between applied science and medical innovation, clinical advances in patient care, social values, public policy, economics and clinical ethics.''—B. Carter, Journal of Perinatology''There are not too many bioethical books that successfully unite philosophical competence in ethical judgment with seasoned medical expertise. This . . . is one of them.''—Claus Dierksmeier, Metapsychology