Ethics consultations in the hospital.

I have just returned from providing an ethics consultation involving one of the situations clinicians hope never to face. A full-term male infant, otherwise healthy, was born with a gastroschisis. Laparotomy on the second day of life revealed no more than 10 cm of functioning intestine. Should total parenteral nutrition be initiated, given the necessity of life-long intervention and the high uncertainty of outcome? Of the many problems facing the clinicians, none weighed more heavily than the ethical aspects of their clinical decision. The attending physicians, residents, and I spent three hours sorting out the ethical issues. Now they must . . .