RESUMO
The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor.
Assuntos
Morte , Obtenção de Tecidos e Órgãos , Humanos , Obtenção de Tecidos e Órgãos/ética , Perfusão , Doadores de Tecidos/ética , Ressuscitação/ética , Circulação SanguíneaRESUMO
BACKGROUND: Decisions about treatments for extremely preterm infants (EPIs) born in the 'grey zone' of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine. METHODS: The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents' views based on profession and neonatal unit designation. Further questions explored respondents' conceptual understanding of viability. RESULTS: 336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks' gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be 'viable' if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team. CONCLUSION: Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks' gestation.
Assuntos
Viabilidade Fetal/fisiologia , Idade Gestacional , Cuidado do Lactente , Lactente Extremamente Prematuro , Cuidados Paliativos , Ressuscitação , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Cuidado do Lactente/ética , Cuidado do Lactente/métodos , Cuidado do Lactente/psicologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Neonatologistas/estatística & dados numéricos , Enfermeiros Neonatologistas/estatística & dados numéricos , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Ressuscitação/ética , Ressuscitação/métodos , Ressuscitação/psicologia , Ordens quanto à Conduta (Ética Médica)/ética , Ordens quanto à Conduta (Ética Médica)/psicologia , Reino Unido/epidemiologiaRESUMO
BACKGROUND: Trauma patients may present with nonsurvivable injuries, which could be resuscitated for future organ transplantation. Trauma surgeons face an ethical dilemma of deciding whether, when, and how to resuscitate a patient who will not directly benefit from it. As there are no established guidelines to follow, we aimed to describe resuscitation practices for organ transplantation; we hypothesized that resuscitation practices vary regionally. METHOD: Over a 3-month period, we surveyed trauma surgeons practicing in Levels I and II trauma centers within a single state using an instrument to measure resuscitation attitudes and practices for organ preservation. Descriptive statistics were calculated for practice patterns. RESULTS: The survey response rate was 51% (31/60). Many (81%) had experience with resuscitations where the primary goal was to preserve potential for organ transplantation. Many (90%) said they encountered this dilemma at least monthly. All respondents were willing to intubate; most were willing to start vasopressors (94%) and to transfuse blood (84%) (range, 1 unit to >10 units). Of respondents, 29% would resuscitate for ≥24 hours, and 6% would perform a resuscitative thoracotomy. Respect for patients' dying process and future organ quality were the factors most frequently considered very important or important when deciding to stop or forgo resuscitation, followed closely by concerns about excessive resource use. CONCLUSION: Trauma surgeons' regional resuscitation practices vary widely for this patient population. This variation implies a lack of professional consensus regarding initiation and extent of resuscitations in this setting. These data suggest this is a common clinical challenge, which would benefit from further study to determine national variability, areas of equipoise, and features amenable to practice guidelines.
Assuntos
Padrões de Prática Médica/ética , Ressuscitação/ética , Doadores de Tecidos/ética , Transplante/ética , Traumatologia/ética , Ferimentos e Lesões/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Ressuscitação/métodos , Inquéritos e Questionários , Tennessee , Centros de Traumatologia/ética , Centros de Traumatologia/estatística & dados numéricos , Traumatologia/estatística & dados numéricosAssuntos
COVID-19/complicações , Tomada de Decisão Clínica/métodos , Viabilidade Fetal , Lactente Extremamente Prematuro , Doenças do Prematuro/terapia , Doenças não Transmissíveis/prevenção & controle , Ressuscitação/ética , COVID-19/epidemiologia , COVID-19/terapia , Tomada de Decisão Clínica/ética , Saúde Global , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Recém-Nascido , Doenças do Prematuro/etiologia , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/métodos , Pandemias , Prognóstico , Qualidade de Vida , Ressuscitação/métodos , Medição de Risco , Fatores de RiscoAssuntos
COVID-19/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual , Ressuscitação , Reanimação Cardiopulmonar/ética , Reanimação Cardiopulmonar/instrumentação , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/ética , Transmissão de Doença Infecciosa do Paciente para o Profissional/legislação & jurisprudência , Máscaras/ética , Máscaras/normas , Máscaras/provisão & distribuição , Equipamento de Proteção Individual/ética , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/provisão & distribuição , Ressuscitação/ética , Ressuscitação/instrumentaçãoRESUMO
Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.
Assuntos
Seleção do Doador/métodos , Rejeição de Enxerto/prevenção & controle , Parada Cardíaca/mortalidade , Preservação de Órgãos/métodos , Transplante de Órgãos/métodos , Aloenxertos/provisão & distribuição , Seleção do Doador/ética , Seleção do Doador/legislação & jurisprudência , Rejeição de Enxerto/etiologia , Acessibilidade aos Serviços de Saúde , Parada Cardíaca/terapia , Humanos , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/ética , Transplante de Órgãos/legislação & jurisprudência , Perfusão/instrumentação , Perfusão/métodos , Ressuscitação/ética , Resultado do Tratamento , Isquemia Quente/efeitos adversosAssuntos
Aconselhamento , Viabilidade Fetal , Lactente Extremamente Prematuro , Neonatologistas , Ressuscitação , Parto Obstétrico , Idade Gestacional , Hospitais de Ensino , Humanos , Recém-Nascido , Transferência de Pacientes , Relações Profissional-Família , Ressuscitação/ética , Taxa de SobrevidaRESUMO
There is very little law-either case law or statutory law - that regulates delivery room decisions about resuscitation of critically ill newborns. Most of the case law that exists is decades old. Thus, physicians cannot look to the law for much guidance about what is permissible or prohibited. Local hospital policies and professional society statements provide some guidance, but they cannot be all-inclusive and encompass all potentially encountered scenarios. Ultimately, the physician, the medical team, and the parents must try to reach a shared decision about the best course of action for each individual infant and each unique family. In this paper, we review some of the case law that may be applicable to such decisions and make recommendations about how decisions should be made.
Assuntos
Estado Terminal , Salas de Parto , Parto Obstétrico , Doenças do Recém-Nascido , Relações Médico-Paciente/ética , Ressuscitação , Adulto , Estado Terminal/psicologia , Estado Terminal/terapia , Tomada de Decisão Compartilhada , Salas de Parto/ética , Salas de Parto/legislação & jurisprudência , Salas de Parto/organização & administração , Parto Obstétrico/ética , Parto Obstétrico/legislação & jurisprudência , Parto Obstétrico/psicologia , Emergências/psicologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/psicologia , Doenças do Recém-Nascido/terapia , Responsabilidade Legal , Complicações do Trabalho de Parto/terapia , Gravidez , Ressuscitação/ética , Ressuscitação/psicologiaRESUMO
OBJECTIVES: We set out to investigate paramedics' views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA). METHODS: An interpretative phenomenological approach was adopted. A purposive sample of paramedics (n=6) from North East Ambulance Service NHS Foundation Trust were invited to a semi-structured, in-depth interview. RESULTS: Three superordinate themes emerged: (1) morality, (2) emotion and (3) equipoise. Some viewed Paramedic-2 as an opportunity to improve OHCA outcomes for the many, viewing participation as a moral obligation; others viewed the study as unethical, equating participation with immoral behaviour. Morality was a motivator to drive individual action. Positive and negative emotions were exhibited by the paramedics involved reflecting the wider view each paramedic held about trial participation. Those morally driven to participate in Paramedic-2 discussed their pride in being associated with the trial, while those who found participation unethical, discussed feelings of guilt and regret. Individual experience and perceptions of epinephrine guided each paramedic's willingness to accept or reject equipoise. Some questioned the role of epinephrine in OHCA; others believed withholding epinephrine was synonymous to denying patient care. CONCLUSION: A paucity of evidence exists to support any beneficial role of epinephrine in OHCA. Despite this, some paramedics were reluctant to participate in Paramedic-2 and relied on their personal perceptions and experiences of epinephrine to guide their decision regarding participation. Failure to acknowledge the importance of individual perspectives may jeopardise the success of future out-of-hospital trials.
Assuntos
Atitude do Pessoal de Saúde , Ensaios Clínicos como Assunto/ética , Auxiliares de Emergência/psicologia , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Adulto , Ambulâncias/ética , Emoções , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Princípios Morais , Seleção de Pacientes/ética , Placebos/administração & dosagem , Pesquisa Qualitativa , Recusa de Participação/ética , Recusa de Participação/psicologia , Ressuscitação/ética , Ressuscitação/métodos , Reino UnidoRESUMO
Requests for hastened death and suicidal ideation may be more prevalent in populations approaching the end of life. Often these wishes and thoughts occur in the context of concurrent psychiatric disorders and emotional suffering. We discuss the case of a veteran with terminal lung cancer and comorbid psychiatric illness who attempted suicide while under the care of an inpatient interdisciplinary hospice team and describe our team's response to this suicide attempt. We review risk factors for suicidality at end of life, challenges of distinguishing desire for hastened death from suicidality, and the ethics of resuscitation of a dying patient after a suicide attempt.
Assuntos
Neoplasias Pulmonares/psicologia , Neoplasias Pulmonares/terapia , Ressuscitação/ética , Tentativa de Suicídio , Doente Terminal , Veteranos/psicologia , Idoso , Atitude Frente a Morte , Evolução Fatal , Humanos , MasculinoRESUMO
The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation at a University Hospital in Northern Italy. After the case was resolved, a retrospective ethical analysis was performed by four clinical ethicists who work in different healthcare contexts (Italy, the United States, and Switzerland). Each ethicist used a different method to analyze the case; the four general approaches provide insight into how these ethicists conduct ethics consultations at their respective hospitals. Concluding remarks examine the similarities and differences among the various approaches and offer a reflection concerning the possibility of a shared resolution to the case. The authors' efforts to come to a tentative consensus may serve as an example for professionals working in medical contexts that reflect an increasing pluralism of values. This article aims to respond to some of these concerns by illustrating how different methods in clinical ethics would be used when considering a real case. The goal is not to establish the best model (if there is one) on a theoretical level, but to learn from actual practice in order to see if there are common elements in the different methods, and to validate their pertinence to clinical ethics consultation.
Assuntos
Tomada de Decisões , Consultoria Ética , Unidades de Terapia Intensiva/ética , Doença Aguda/terapia , Vértebras Cervicais/lesões , Traumatismos Craniocerebrais/terapia , Diversidade Cultural , Família , Fraturas Ósseas/terapia , Humanos , Masculino , Futilidade Médica/ética , Pessoa de Meia-Idade , Princípios Morais , Preferência do Paciente , Qualidade de Vida , Ressuscitação/ética , Traumatismos da Medula Espinal/terapia , Recusa do Paciente ao Tratamento/éticaRESUMO
INTRODUCTION: Family presence during resuscitation (FPDR), remains inconsistently implemented by emergency personnel. The benefits for family members is well documented, providing opportunities for family to say goodbye, facilitates closure and enables family to provide emotional support to the patient. The aim of this study was to explore the experiences and attitudes of emergency personnel towards FPDR immediately post resuscitation events. METHOD: A descriptive qualitative design was used to explore the experiences of emergency personnel with FPDR. Data was collected from single rural and metropolitan emergency departments in the state of Victoria, Australia. The participants consisted of nurses and doctors who took active roles during resuscitation events. Following transcription of the audiotaped interviews Creswell's (2003) six step analysis process was employed. RESULT: A total of 29 interviews of key personnel, following 6 paediatric and 18 adult resuscitation events. Interviews were conducted over a period of two weeks in each venue. The data was organised into six themes following analysis including: care coordinators inconsistently called, gate keepers to implementation, effective communication strategies helping to deliver bad news, life experience generates confidence, allocation of family support person, and family members roles dependent on age of patient. CONCLUSION: FPDR is common practice in paediatric events however remains inconsistently implemented during adult resuscitations. A designated family support person is essential to successful implementation of FPDR and should be incorporated in to the allocation of the resuscitation team roles during both adult and paediatric resuscitation events. Education and training is important for clinicians to learn essential communication skills, building practice confidence, which is required to successfully implement FPDR.
Assuntos
Atitude do Pessoal de Saúde , Serviço Hospitalar de Emergência , Família/psicologia , Médicos/psicologia , Relações Profissional-Família/ética , Pesquisa Qualitativa , Ressuscitação/ética , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação/psicologia , Inquéritos e Questionários , VitóriaRESUMO
Uncontrolled donation after circulatory death, which occurs when an individual has experienced unexpected cardiac arrest, usually not in a hospital, generates both excitement and concern. On the one hand, uDCD programs have the capacity to significantly increase organ donation rates, with good transplant outcomes-mainly for kidneys, but also for livers and lungs. On the other hand, uDCD raises a number of ethical challenges. In this essay, we focus on an issue that is central to all uDCD protocols: When should we cease resuscitation and shift to organ preservation? Do current uDCD protocols prematurely consider as potential donors patients who could still have some chances of meaningful survival? Can the best interest of patients be fostered once they are considered and treated as potential donors?
Assuntos
Morte , Cuidados para Prolongar a Vida , Ressuscitação , Coleta de Tecidos e Órgãos , Obtenção de Tecidos e Órgãos , Tomada de Decisão Clínica , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Humanos , Cuidados para Prolongar a Vida/legislação & jurisprudência , Cuidados para Prolongar a Vida/métodos , Ressuscitação/ética , Ressuscitação/métodos , Ordens quanto à Conduta (Ética Médica) , Coleta de Tecidos e Órgãos/ética , Coleta de Tecidos e Órgãos/legislação & jurisprudência , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/métodosRESUMO
BACKGROUND: Critically ill or injured emergency department or prehospital patients who lack decision-making capacity sometimes present with a non-standard advance directive, such as a "Do Not Resuscitate" tattoo or medallion. Emergency clinicians must immediately address the question of whether to withhold treatment based on what may or may not be a valid patient directive. DISCUSSION: Advance directives have been standardized for a good reason. Emergency department or prehospital healthcare providers must be able to immediately interpret and act on them without needing a legal interpretation. When faced with non-standard directives, physicians can follow them, ignore them, or simply use them as an additional piece of information about the individual's wishes for some situations at one point in his or her life. Absent the patient's input or that of aknowledgeable surrogate, both the patient's initial reasons for their non-standard directive and his or her present wishes concerning resuscitation cannot be independently known. Therefore, healthcare providers must initiate treatment while they buy time, attempt to return the patient to lucidity, and search for probative information regarding their current wishes concerning medical treatment. Without such additional information, the moral weight will always favor initiating treatment, since withholding treatment is often irreversible and any treatment instituted can later be withdrawn.
Assuntos
Diretivas Antecipadas/tendências , Tomada de Decisões , Ressuscitação/ética , Diretivas Antecipadas/ética , Medicina de Emergência/métodos , Medicina de Emergência/tendências , Serviço Hospitalar de Emergência/organização & administração , Humanos , Ressuscitação/tendências , Tatuagem/efeitos adversos , Tatuagem/tendênciasRESUMO
Spirituality is becoming of increasing importance in the international healthcare context. While patients' spirituality or faith is often overlooked, there is a growing awareness that understanding, addressing and supporting patients' spiritual and faith needs can influence healthcare outcomes. This review aims to illuminate this role and highlight healthcare chaplains' potential in relation to the provision of pastoral support for families during and after patient resuscitation, and the dearth of interdisciplinary education in this field. A rapid structured review was undertaken using four databases-PubMed, CINAHL, PsycINFO and ATLA. Primary research studies published during the 10-year period 2007-2017 written in English addressing the chaplain's role or perceived role in resuscitation were included. An initial search using key terms yielded 18 relevant citations. This reduced to 11 once duplicates were removed. Ultimately five relevant primary research studies were included in the final analysis. This review found few studies that directly explored the topic. Certainly many view the chaplain as a key member of the resuscitation team, although this role has not been fully explored. Chaplains likely have a key role in supporting families during decisions about 'not for resuscitation' and in supporting families during and after resuscitation procedures. Chaplains are key personnel, already employed in many healthcare organisations, who are in a pivotal position to contribute to future developments of spiritual and pastoral care provision and support. Their role at the end of life, despite well described and supported, has received little empirical support. There is an emerging role for chaplains in healthcare ethics, supporting end-of-life decisions and supporting family witnessed resuscitation where relevant. Their role needs to be more clearly understood by medical staff, and chaplain's input into undergraduate medical education programmes is becoming vital.
Assuntos
Serviço Religioso no Hospital/organização & administração , Clero , Assistência Religiosa/métodos , Ressuscitação , Espiritualidade , Adulto , Atenção à Saúde , Humanos , Ressuscitação/ética , Ressuscitação/psicologiaRESUMO
Neonatal resuscitation is provided to approximately 3% of neonates. Adequate ventilation is often the key to successful resuscitation, but this can be difficult to provide. There is increasing evidence that inappropriate respiratory support can have severe consequences. Several neonatal intensive care units have recorded and reviewed neonatal resuscitation procedures for quality assessment, education and research; however, ethical dilemmas sometimes make it difficult to implement this review process. We reviewed the literature on the development of recording and reviewing neonatal resuscitation and have summarised the ethical concerns involved. Recording and reviewing vital physiological parameters and video imaging of neonatal resuscitation in the delivery room is a valuable tool for quality assurance, education and research. Furthermore, it can improve the quality of neonatal resuscitation provided. We observed that ethical dilemmas arise as the review process is operating in several domains of healthcare that all have their specific moral framework with requirements and conditions on issues such as consent, privacy and data storage. These moral requirements and conditions vary due to local circumstances. Further research on the ethical aspects of recording and reviewing is desirable before wider implementation of this technique can be recommended.
Assuntos
Ética Médica , Unidades de Terapia Intensiva Neonatal/ética , Garantia da Qualidade dos Cuidados de Saúde/ética , Ressuscitação/ética , Gravação em Vídeo/ética , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/normasRESUMO
AIM: We aimed to evaluate mortality and short-term neonatal morbidity of babies born ≤500 g cared for in the Northern Neonatal Network over a 15-year period. METHOD: Using regional databases, we identified all live-born babies ≥22 weeks gestation and ≤500 g, in North East England and North Cumbria from 1998 to 2012. We quantified major neonatal morbidities and survival to one year. RESULTS: We identified 104 live-born babies ≥22 weeks gestation and ≤500 g (birth prevalence 0.22/1000), of which 49 were admitted for intensive care. Overall one-year survival was 11%, but survival for those receiving intensive care was 22%. There was significant short-term neonatal morbidity in survivors, in particular retinopathy of prematurity and chronic lung disease. CONCLUSION: Survival of babies born weighing ≤500 g in this cohort remains poor despite advances in neonatal care, with considerable short-term neonatal morbidity in survivors. This could be due to a combination of attitudes and a rather conservative approach towards resuscitation and intensive care, and the intrinsic nature of these tiny babies.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Doenças do Prematuro/mortalidade , Terapia Intensiva Neonatal , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Masculino , Ressuscitação/éticaRESUMO
BACKGROUND: Maternal cardiac arrest during gestation constitutes a devastating event. Training and anticipant preparedness for prompt action in such cases may save the lives of both the woman and her fetus. OBJECTIVES: To address a previous Jewish guideline that a woman in advanced pregnancy should not undergo any medical procedure to save the fetus until her condition is stabilized. METHODS: Current evidence on perimortal cesarean section shows that immediate section during resuscitation provides restoration of the integrity of the mother's vascular compartment and increases her probability of survival. We analyzed Jewish scriptures from the Talmud and verdicts of the oral law and revealed that the Jewish ethical approach toward late gestational resuscitation was discouraged since it may jeopardize the mother. RESULTS: We discuss the pertinent Jewish principles and their application in light of emerging scientific literature on this topic. An example case that led to an early perimortem cesarean delivery and brought about a gratifying, albeit only partially satisfying outcome, is presented, albeit with only a partially satisfying outcome. The arguments that were raised are relevant to such cases and suggest that previous judgments should be reconsidered. CONCLUSIONS: The Jewish perspective can guide medical personnel to modify and adapt the concrete rules to diverse clinical scenarios in light of current medical knowledge. With scientific data showing that both mother and fetus can prosper from immediate surgical extrication of the baby during resuscitation of the advanced pregnant woman, these morals should dictate training and practice in urgent perimortal cesarean sections whenever feasible.