Care at the edge of viability: Medical and ethical issues

Marlyse F. Haward, Nancy W. Kirshenbaum, Deborah E. Campbell

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


Decision-making for extremely immature preterm infants at the margins of viability is ethically, professionally, and emotionally complicated. A standard for prenatal consultation should be developed incorporating assessment of parental decision-making preferences and styles, a communication process involving a reciprocal exchange of information, and effective strategies for decisional deliberation, guided by and consistent with parental moral framework. Professional caregivers providing perinatal consultations or end-of-life counseling for extremely preterm infants should be sensitive to these issues and be taught flexibility in counseling techniques adhering to consistent guidelines. Emphasis must shift away from physician beliefs and behaviors about the boundaries of viability.

Original languageEnglish (US)
Pages (from-to)471-492
Number of pages22
JournalClinics in Perinatology
Issue number3
StatePublished - Sep 2011


  • Decision-making
  • Ethics
  • Extreme prematurity
  • Periviability

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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