Advances in perinatology have permitted the survival of fragile neonates. Quality of life has been considered a key element in medical decision-making. In this review we analyse the role of Q...

Medicine is moving away from reliance on the proclamations of authorities to the use of numerical methods to estimate the size of effects of its interventions. But a rumbling note of uneasiness underlines present-day medical progress: the more we know, The more questions we encounter about what to do with the hard-won information. The essays in Where's the Evidence examine the dilemmas that have arisen as the result of medicine's unprecedented increase in technical powers. How do doctors draw the line (...) between "knowing" (the acquisition of new medical information) and doing" (the application of that new knowledge)? What are the long-term consequences of responding to the demand that physicians always do everything that can be done? Is medicine's primary aim to increase the length of life? Or is it to reduce the amount of pain and suffering? And who is empowered to choose when these ends are mutually exclusive? This engaging collection of essays will be of interest to professionals interested in the evidence-based medicine debate, including epidemiologists, neonatologists, those involved in clinical trials and health policy, medical ethicists, medical students, and trainees. (shrink)

You can’t build if you don’t dwell first. This sentence is counterintuitive. It is usually thought that first you build, and then you dwell where you have built. But if you don’t dwell where you want to build, you may not understand the landscape, and the building will be weak or crippled.In Latin, “to dwell” is habitare, which comes from the verb habere, “to own.” The phrase “You can’t build if you don’t dwell first” can be considered the leitmotif of (...) the “Yes to Life” Congress, held in Vatican City in 2019. The goal of the conference was to overcome prejudices and preconceptions about the correct approach to end-of-life cases in perinatology. Overcoming prejudices about this particular stage of life is hard in... (shrink)

Neural tube defects (NTDs) are very serious malformations for the fetus, causing either low life expectancy or a chance of survival only with costly and difficult surgical interventions. In western countries the average prevalence is 1/1000-2000 and in Turkey it is 4/1000. The aim of the study was to characterize ethical approaches at institutional level to the fetus with an NTD and the mother, and the role of health care professionals in four major centers in Turkey. The authors chose (...) class='Hi'>perinatology units of four university hospitals and prepared questionnaires for the responsible professionals concerning their own and their institution’s ethical approaches to the fetus with an NTD and the mother. The investigation revealed that there were no institutional ethical frameworks or ethics committees available to professional teams in the units. The roles of the health care professionals and their individual decisions and approaches based on ethical principles are described. The ethical decision-making process concerning fetuses with NTDs, examples of institutional approaches to the topic and institutional frameworks, and the role of nurses and other health care professionals are all discussed, based on a literature review. The authors suggest that institutional ethical frameworks, ethics committees, professionals’ ethics education and multidisciplinary teamwork should be established for critical situations such as fetuses with an NTD. (shrink)

As part of a volunteering program, a medical student learns the story of a sick infant whose survival was wholly dependent on modern medicine. The family was pacified by believing, during pregnancy, that the fetus would be healthy. Poor counseling and unethical physician behavior led to the trauma of the family’s struggle to keep its baby alive, happy, and as healthy as possible. The need for adequate, thorough, and individualized counseling is a critical and still unfulfilled need in patient care.

Celebrated for disproving the traditional view that lack of oxygen at birth (perinatal asphyxia) contributes significantly to cerebral palsy, a 1986 New England Journal of Medicine article by Karin Nelson and Jonas Ellenberg engineered a new consensus in the medical community: that lack of oxygen at birth rarely causes cerebral palsy. We demonstrate that the article's central argument relies on straightforwardly fallacious statistical reasoning, and we discuss significant implications -- e.g. how carefully fetuses are monitored during labor and delivery, expert (...) testimony in malpractice cases, and public policy decisions. (shrink)