The Opinion Group of the Bioethics and Law Observatory of the University of Barcelona (OBD), located at the Barcelona Science Park, presented today a document endorsing the limitation of therapeutic efforts in neonatology units as good medical practice under certain circumstances, such as extremely premature neonates, whose long-term survival is not possible; neonates with very serious diseases who suffer continuously and for which current medical knowledge offers no means of relief, or who require continuous intensive treatments and have a very poor prognosis in terms of quality of life, present or future. In this way, the intention is to generate a social debate on this matter, which is not openly discussed and which is left to the discretion of healthcare teams and the neonate's parents, amongst other reasons, given that it entails complex ethical questions and there is not a clear legal framework to determine which intervention protocols to follow.

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Several specialists from different fields, under the coordination of Dr. Frederic Raspall, head of the Service of Neonatology and Pediatrics of the Hospital of Barcelona, and Dr. Albert Royes, secretary of the Bioethics Committee of the University of Barcelona and member of the Healthcare Ethics Committee of the Clinical Hospital, have participated in the development of the document on the limitation of therapeutic efforts in neonatology units.

The “Declaration on the limits to therapeutic efforts in neonatal care units” includes a series of recommendations, with the aim of ensuring that the decision to limit therapeutic efforts in the three aforementioned situations is justified from an ethical and legal point of view, and, hence, defines a series of requirements that should be fulfilled before making any decisions on this matter.

In the case of extremely premature neonates or those with very serious diseases, the OBD recommends, firstly, maximum reliability in diagnosis and prognosis and, if necessary, consultation with other healthcare teams; agreement on the part of the neonate’s parents, who should receive sufficient, honest and true information from the medical team in order to determine their agreement or not, which should always be explicit and in written form; and that the decision to limit therapeutic efforts is accompanied by the most appropriate measures to manage symptoms and prevent or suppress the pain or suffering the neonate may be experiencing.

Additionally, in the case of neonates whose death is not imminent, but who must undergo constant intensive treatments, the OBD indicates that both the healthcare team and the parents, after prior agreement and always upholding the neonate’s best interests, acknowledge the repercusions that new medical treatments or continuation of treatments could have on the neonate’s quality of life. In this regard, the OBD suggests that, in these cases, essential aspects be taken into account, such as the continuous dependency of intensive medical procedures, the current and future capacity of the neonate to establish relationships with other people and to interact with his/her environment, the intensity of pain and suffering he/she experiences, as well as that the balance between benefits and damage clearly leans towards the certitude that prolonging his/her life is not the best alternative.