Ethics in Neonatal Neurology: When is Enough, Enough?

Decision-making for the severely neurologically compromised newborn is fraught with considerable medical and ethical difficulties. Multiple intrinsic and extrinsic factors challenge our prognostic certainty, which then challenges our ability both to communicate and to make decisions that are rooted in basic principles of fairness and moral integrity. Clinical vignettes illustrate the difficulties and highlight the present status regarding prognostication and consideration of general ethical principles that would permit the consensual withdrawal of care (i.e., end-of-life decisions). Futility in the neonatal setting is examined, as well the mechanisms of the decision-making process and existing relevant professional guidelines.