Mark Mercurio, MD, MA, Chief of Neonatal-Perinatal Medicine at Yale School of Medicine and Director of the Yale Pediatrics Ethics Program, visits Quarterly Questions in Neonatal Ethics to discuss controversial end-of-life decisions in pediatrics and neonatology.
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0:00 Introduction
0:31 Pediatric ethics and the story of Mrs. Smith
3:48 Deciding for others
7:05 The role of the physician?
9:12 The role of the clinician?
10:40 Ethical decisions in pediatrics Shared decision-making should be our approach...
11:01 How to Decide Anything... Candidate method: standard of care
15:22 Fundamental question
16:56 Location on the line for any therapy is not static movement based on change in prognosis
19:59 Candidate justification for impermissibility: "It would be futile"
23:27 Ought implies can
25:00 Rights based analysis
28:36 ECMO in setting of Trisomy 21
29:01 Moral Status
31:45 Transparency
34:21 The self-fulfilling prophecy
36:37 Attempting resuscitation in the setting of extreme prematurity - the potential for injustice
37:55 Resuscitation in extreme prematurity based on GA alone - parental choice and the potential for injustice
41:33 Not every decision is life and death
45:10 Function as a team, and think ahead
45:47 What is needed to make the system work?
45:51 Professional humility
48:02 Final thought: moral agency
