Pediatricians' Attitudes Affecting Decision-Making in Defective Newborns

Abstract

A questionnaire designed to identify the factors that influence the resolution of ethical dilemmas was returned by 230 (57% of the total) Massachusetts pediatricians. The decision to recommend surgery for an infant with Down's syndrome with duodenal atresia when the parents had refused surgery was influenced by religious affiliation (P < .01), religious activity (P < .04), and sex (P = .05). Of those favoring surgery, 40.2% would pursue a court order. The decision to recommend surgery for an infant with severe meningomyelocele when the parents' position was not stated was influenced by age (P < .01), religious activity (P < .02), and specialization (P < .008). When the parents' wishes were expressed, the majority of the pediatricians modified their decision in accord with these wishes. In response to general ethical questions, 79.6% of all pediatricians thought that parents should have the right to withold consent for surgery. Equal numbers thought that psychosocial reasons justified withholding lifesaving procedures. Among a variety of factors, they thought that willingness of the parents to care for the child would influence the decision to take heroic measures. There were 90.4% who thought that ethics should be part of medical education; 55.7% indicated this need throughout their careers.