Neonatology and the specter of the law

When I began my career with dual training in bioethics and law, my research and clinical interests were focused on the suffering of terminally ill adults due to unwanted treatment and how perceptions of law among health care providers contributed to this problem. A central goal of my work was to try to prevent situations where physicians would aggressively continue to treat patients in ways contrary to their expressed wishes and ignore the attempts of family members to implement the preferences of their loved ones. It was apparent that some physicians were so anxious about the impact of legal factors on their practice that they were willing to tolerate additional suffering of patients to protect themselves. Further, I suspected that many of these physicians were not well versed in the nuances of applicable laws and were making these judgments with inaccurate information. Hence my research was designed, in part, to dispel misperceptions by physicians of legal constraints on their practice and encourage them to educate themselves about law. I also hoped to suggest that some physicians modify their approach to cases of serious illness to evaluate all elements of the case proportionally, carefully considering the impact of suffering on both patients and families, rather than ascribing excessive importance to the impact of legal factors. Later in these pages, I will briefly describe some results of this research regarding cases of adult patients. As I became involved with ethical issues in neonatology, however,