Extremely premature birth bioethical decision-making supported by dialogics and pragmatism

BMC Medical Ethics

Debate

Gregory P. Moore¹  Joseph W. Kaempf² 

[1] Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital – General Campus, Box 806, 501 Smyth Road, K1H 8L6, Ottawa, ON, Canada;Providence St. Vincent Medical Center, Women and Children’s Services, 9205 SW Barnes Road, 97225, Portland, OR, USA;

关键词: Ethics-medical;    Extreme premature birth;    Decision making;    Uncertainty;    Value pluralism;    Morality;   

DOI  :  10.1186/s12910-023-00887-z

 received in 2022-05-26, accepted in 2023-01-26,  发布年份 2023

来源: Springer

【 摘 要 】

Moral values in healthcare range widely between interest groups and are principally subjective. Disagreements diminish dialogue and marginalize alternative viewpoints. Extremely premature births exemplify how discord becomes unproductive when conflicts of interest, cultural misunderstanding, constrained evidence review, and peculiar hierarchy compete without the balance of objective standards of reason. Accepting uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and especially crucial in our world of constrained resources. We think dialogics engender a mutual understanding that: i) transitions beliefs beyond bias, ii) moves conflict toward pragmatism (i.e., the truth of any position is verified by subsequent experience), and iii) recognizes value pluralism (i.e., human values are irreducibly diverse, conflicting, and ultimately incommensurable). This article provides a clear and useful Point-Counterpoint of extreme prematurity controversies, an objective neurodevelopmental outcomes table, and a dialogics exemplar to cultivate shared empathetic comprehension, not to create sides from which to choose. It is our goal to bridge the understanding gap within and between physicians and bioethicists. Dialogics accept competing relational interests as human nature, recognizing that ultimate solutions satisfactory to all are illusory, because every choice has downside. Nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1