The Edge of Perinatal Viability: Understanding the Dutch Position

Frontiers in Pediatrics

H. Ismaili M'hamdi¹  L. De Proost²  R. Geurtzen³  I. K. M. Reiss⁴  E. A. P. Steegers⁵  E. J. T. Verweij⁶  A. A. E. Verhagen⁷ 

[1] Department of Medical Ethics, Philosophy and History of Medicine, Rotterdam, Netherlands;Department of Medical Ethics, Philosophy and History of Medicine, Rotterdam, Netherlands;Department of Neonatology, Rotterdam, Netherlands;Department of Obstetrics and Gynecology, Rotterdam, Netherlands;Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands;Department of Neonatology, Rotterdam, Netherlands;Department of Obstetrics and Gynecology, Rotterdam, Netherlands;Department of Obstetrics and Gynecology, Rotterdam, Netherlands;Department of Obstetrics, Leiden University Medical Center (LUMC), Leiden, Netherlands;Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands;

关键词: extremely premature birth;    threshold of viability;    guidelines;    decision-making;    medical ethics;   

DOI  :  10.3389/fped.2021.634290

来源: Frontiers

【 摘 要 】

The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.

【 授权许可】

CC BY