Ethical issues in the care of extremely low birth weight infants.

This article examines the difficulties in making decisions about the medical treatment of infants who have uncertain viability because of extremely low birth weight. The advantages and disadvantages of three systematic approaches are reviewed. An approach called "provisional intensive care for all" may offer the most benefit and cause the least harm. With this approach, all liveborn infants would be presumed viable and would receive intensive care, at least initially. After further assessment of the infant, the parents would be informed as fully as possible about the possible outcome of continuing intensive care. The treating physicians would offer the parents the options of continuing intensive care or withdrawing it and providing basic care. Although the physicians would provide recommendations based on their best medical judgment, they would be prepared to support and carry out the parents' decision.