Three Decades after Baby Doe: How Neonatologists and Bioethicists Conceptualize The Best Interests Standard

OBJECTIVE: Determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS). STUDY DESIGN: Members of the ASBH and the AAP Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life sustaining therapy. RESULT: Neonatologists' median response supported an infant-specific BIS conceptualization that linked the infant's and family's interests. They did not support allowing limitations on the family's obligations. Ethicists' supported a conceptualization that linked the infant's and family's interests and limitations on the family's obligations, a less infant-specific conceptualization. Ethicists were less or equally likely to agree with forgoing LST in 7 of 8 cases. CONCLUSION: Ethicists endorsed a conceptualization of the BIS that includes the effects on the family and rejected an infant-specific one. Neonatologists split between these two and rejected limiting the family's obligations. Critical appraisal of the BIS is needed in neonatal ethics.