Objective: Our purpose was to clarify the roles of parents and caregivers in making decisions for resuscitation of near-viable infants.
Study design: We present two cases and review ethical and legal issues involved in making decisions for near-viable infants.
Results: Medical responsibility for the infant shifts at birth from obstetrics to neonatology. Neonatologists will "opt for life" when prognosis is uncertain. As surrogate decision makers, parents have rights to make decisions about initiation of resuscitation, but these parental rights are limited by the infant's best interests. If caregivers believe parents are not acting in the infant's best interests, they may persuade parents, challenge parental refusal by petitioning the courts, or treat without consent with possible legal risk.
Conclusions: Effective communication is essential to prevent misunderstanding and conflicts. In most instances parents are the best decision makers for a near-viable infant. Parental rights are limited by best interests of the infant.