Default options and neonatal resuscitation decisions.
J Med Ethics
; 38(12): 713-8, 2012 Dec.
Article
em En
| MEDLINE
| ID: mdl-23180252
ABSTRACT
OBJECTIVE:
To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. MATERIALS ANDMETHODS:
Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression.RESULTS:
Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate.DISCUSSION:
Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy.CONCLUSION:
Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos
/
Comunicação Persuasiva
/
Ordens quanto à Conduta (Ética Médica)
/
Revelação
/
Autonomia Pessoal
/
Tomada de Decisões
/
Salas de Parto
/
Lactente Extremamente Prematuro
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
/
Male
/
Newborn
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article