Ética neonatal: o recém-nascido prematuro no limite da viabilidade

Abstract

With the technological improvement and neonatal care, there was an increasing on both survival rates of extremely premature newborns (EPN), as on the prevalence of chronic morbidity and disability in survivors. The objectives of this paper are the critical description of the ethics/ bioethics principles that are often evoked to justify the decisions on resuscitation and/or continued treatment of EPN at the limit of viability, the considerations on the difficult choices involving the premature infant, his family and health care professionals, and the consideration of guidelines in several countries. A non-systematic review was made in databases (Medline, LILACS and SciELO), 2000-2013, and on literature about bioethics issues involving EPN. In a reality of decreasing limit of viability, followed by the increase survival rates of EPN and more frequent morbidities, the main discussion is about the gray zone, which is around 23 and 24 gestational age, presently, with uncertain prognosis and high risk of serious disabilities. In that, the ethical issues are evaluated based on contemporary theories, such as personalism, utilitarianism and principlism that guide bioethics evaluations. On the decision making process for the EPN, the moral status, the best interest, the quality of life, the futility and parental participation are the points considered. Guidelines and clinical protocols arise in several countries to guide decision-making at the NICU and are developed based on bioethical questions are reflections involved in decision-making about EPN. It should be brought in mind an individualized conduct for each mother/EPN in decision making at the limit of viability, based on medical and technological knowledge and involved bioethical principles, valuing life and avoiding therapeutic obstinacy.