Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence

Authors

  • Annie Janvier,

    1. .Division of Neonatology and Clinical Ethics, Department of Pediatrics, University of Montreal, Sainte-Justine Hospital, Montreal, QC, Canada
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  • John M Lorenz,

    1. .Division of Neonatology, Department of Pediatrics, Columbia University, Morgan Stanley Children’s Hospital of New York Presbyterian, New York Presbyterian Hospital, New York, NY, USA
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  • John D Lantos

    1. . Department of Pediatrics, Children’s Mercy Bioethics Center, University of Missouri Kansas City, Children Mercy Hospital, Kansas City, MO, USA
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Annie Janvier B.Sc., M.D., Ph.D., Division of Neonatology and Clinical Ethics, Department of Pediatrics, University of Montreal, Sainte-Justine Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T-1C5, Canada.
Tel: (514) 345 4931; ext 3305 |
Fax: (514) 345 4788 |
Emails: anniejanvier@hotmail.com;annie.janvier@umontreal.ca

Abstract

When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines.

Conclusion:  We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.

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