International perspectives on treatment choice in neonatal intensive care units

Over the past 25 years, neonatal intensive care units (NICUs) have been established throughout the industrialized world and in some Third World nations to provide sophisticated medical interventions for critically ill newborns. This paper discusses the four major factors affecting treatment choices for newborns with disabilities or at risk for disabilities: the availability of resources, societal attitudes toward medical interventions and life with disabilities, the roles of physicians, parents and other decision-makers, and the role of the law. Much has been written on the bioethical issues surrounding such treatment as it is practiced in the United States, including analysis by social scientists; however, little has been written on how those issues are perceived and dealt with in most other nations, and very little comparative research has been conducted. The author provides an international perspective on the bioethical issues involved by comparing U.S. practice, which has received much attention, with a generalized commentary on practices in other parts of the world, which have received less examination. The nations surveyed include Australia, Brazil, Britain, Canada, China, France, India, Israel, Japan, the Netherlands, Poland, Sweden, and West Germany. The value of further comparative research is discussed in order to encourage others to do such research.