Volume 20, Issue 1, Page 6 - January/February 2000

Journal of Perinatology

January/February 2000, Volume 20, Issue 1, Pages 6 - 12

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Original Article

Moral and Ethical Dilemmas in Critically Ill Newborns: A 20-Year Follow-Up Survey of Massachusetts Pediatricians
I. David Todres, MD¹, Jeanne Guillemin, PhD², Elizabeth A. Catlin, MD¹, Aimée Marlow, MA² & Anne Nordstrom, PhD³
¹Departments of Pediatrics and Anesthesia (I. D. T., E. A. C.), Harvard Medical School, Pediatric Service of the Massachusetts General Hospital, Boston, MA; ²Department of Sociology (J. G., A. M.), Boston College, Boston, MA; ³Department of Sociology (A. N.), University of New Hampshire, Durham, NH.

Correspondence to: Elizabeth A. Catlin, MD, Massachusetts General Hospital, Founders House 437, Fruit Street, Boston, MA 02114.

E. A. C. is the 1999 recipient of a Kenneth B. Schwartz Fellowship grant in Clinical Pastoral Education.

Abstract

Surveys of Massachusetts pediatricians in the 1970s and 1980s indicated changing attitudes concerning life-saving treatment of newborns, from less to increased intervention.
OBJECTIVE:
To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates.
STUDY DESIGN:
A long-term follow-up survey of American Academy of Pediatrics Massachusetts membership, maintaining the 1987 instrument, was initiated.
RESULTS:
A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians’ attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making.
CONCLUSION: This study indicates stability and consensus in pediatricians’ attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy.