Ethics at the Margins of Viability

Abstract

In this article, I discuss traditional philosophical descriptions of how to approach the ethical dilemmas presented by infants born at the margins of viability (currently, 23–24 weeks’ gestation). I then juxtapose these philosophical approaches to what might be called evidence-based ethics, in which the evidence in question is the predictive power of physicians to counsel parents regarding the likely outcome of these infants either before or after delivery. I suggest that the predictive power of data available before delivery are insufficient to allow a rational best-interests decision to be made, and that data available after birth promote a more nuanced approach to ethical decision-making for this difficult problem.