Ethics of selective non-treatment in extremely tiny babies

Extremely tiny babies are human beings who deserve the same respect that we would wish if we were critically ill. Non-treatment may have to be considered by medical staff because (a) maximum intensive care can increase pain and prolong the process of dying, (b) the quality of life of some survivors with bilateral parenchymal brain lesions, chronic lung disease, necrotizing enterocolitis and retinopathy is extremely poor, and (c) shortage of resources creates de facto rationing of care. Our personal practice is based on four steps (i) accurate diagnosis and assessment of prognosis, (ii) unanimous decision among medical and nursing staff to stop intensive care, (iii) presentation of the medical assessment to the parents, and (iv) if the parents accept the decision, palliative care with symptomatic relief as intensive care is stopped.