The issue of extremely premature birth is a complex one, fraught with divergent cultural, religious, and ethical beliefs that can make it difficult to reach a consensus on what the appropriate course of action should be. Medical professionals are often risk-averse, and as a result, they may be more likely to make decisions that are in their best interest rather than those of the patient or the patient’s family.
This can lead to arbitrary lines of demarcation being drawn that deny the ambiguous nature of nearly every aspect of extremely premature birth. Disagreements on moral values in healthcare have become a significant challenge that diminishes dialogue and marginalizes alternative viewpoints. In the case of extremely premature births, conflicts of interest, cultural misunderstandings, constrained evidence review, and peculiar hierarchy often compete without the balance of objective standards of reason, leading to unproductive discord.
Acknowledging uncertainty, distributing risk fairly, and humbly acknowledging therapeutic limits are honorable traits, not relativism, and are especially crucial in a world of constrained resources. To address these issues, a group of physicians and bioethicists propose a model based on the principles of dialogics and pragmatism.
Through dialogics, competing relational interests are accepted as human nature, recognizing that ultimate solutions satisfactory to all are illusory because every choice has a downside. Pragmatism moves conflict toward a practical and flexible approach, where the truth of any position is verified by subsequent experience. Value pluralism is also recognized, acknowledging that human values are irreducibly diverse, conflicting, and ultimately incommensurable.
The issue of extremely premature birth is often framed in terms of passionate ideology regarding palliative care versus neonatal intensive care for these infants, which can have a significant impact on health and social outcomes. As mentioned in BMC Medical Ethics, this issue is often less examined than medical interventions and therapies, and the family’s preferences regarding care can be viewed as acceptable or not, depending on individual beliefs and emotions.
The authors of this article propose an alternative model based on the principles of dialogics and pragmatism. The goal of this model is to bridge the collective understanding gap between physicians and bioethicists when it comes to the issue of extremely premature birth. The authors believe that this can be achieved by encouraging a more empathetic understanding of the issue and by fostering a collective consciousness that encourages listening and information exchange.
To achieve their goal, the authors have capsulized recent long-term neurodevelopmental outcome reports for extremely premature infants in an objective shared decision-making table. They have also provided a practical Point-Counterpoint of divergent viewpoints related to extreme prematurity, and illustrated the productive nature of dialogics and pragmatism as methodologies that encourage collective understanding and decision-making.
The issue of extremely premature birth is a complex one that requires a more nuanced approach than simply drawing arbitrary lines of demarcation. By encouraging a more empathetic understanding of the issue and fostering a collective consciousness that encourages listening and information exchange, the authors believe that a consensus can be reached that takes into account the diverse beliefs and emotions of all stakeholders involved in this difficult decision-making process.
