Quality of life and the critically ill newborn: Life and death decision making in the neonatal context.

摘要

Therapeutic and technologic innovations in neonatal medicine have made it possible to save many critically ill newborns who would have died in the past. Unfortunately, some newborns saved survive only briefly despite aggressive attempts to keep them alive, while others survive long-term only to live in tragically impaired states. Given this reality, the question no longer is "Can we save this newborn's life?" but "What kind of life are we saving?" This shift in the question manifestly indicates that quality of life has become increasingly important in neonatal decision making.;Notwithstanding its importance, quality of life poses many problems, most notably, it is subject to vast interpretation and immoral application. One reason for this is that there is not one fully developed quality of life position, but many that differ in significant ways. Yet despite the differences, each quality of life position more or less fits into one of three broad approaches, namely: the social quality of life approach centered explicitly on the newborn and familial-societal factors; the individual quality of life approach centered explicitly on the newborn and only implicitly on familial-societal factors; and the relational quality of life approach centered on the relation between the newborn's medical condition and the newborn's ability to pursue life's goals as these are generally understood.;This dissertation reviews representative positions within the three broad quality of life approaches and evaluates the approaches from a moral perspective with the express purpose of determining how quality of life should be defined and applied morally in the neonatal context. The central thesis of this dissertation is that the relational quality of life approach is the most morally plausible in terms of its definition of "quality" of life, viewpoints about the evaluative status of physical life, and considerations about the normative dimensions of quality of life.