The ethics of resuscitation in extremely premature infants

Extremely preterm birth at 23–25 weeks’ gestational age represents a profound ethical “grey zone,” where resuscitation is neither universally obligatory nor impermissible. While survival and neurodevelopmental outcomes have improved, prognostication remains shaped not only by clinical factors such as birth weight, antenatal steroid use, and tertiary care access, but also by unacknowledged contextual variables including geography, social resources, and caregiver support. Current frameworks rooted in principlism often fail to adequately incorporate relational, societal, and disability-related bias. This presentation examines neonatology’s traditional binary framing through the lens of the I–P–O (Infant–Parent–Outcome) framework and Zone of Parental Discretion, highlighting how bias at the individual, specialty, and societal levels influences what is offered versus what is said. Alternative ethical lenses such as: virtue ethics, communitarianism, casuistry, and the harm principle are proposed as tools to better navigate uncertainty. Ultimately, this session reframes the central question not as what is the right answer, but do we have the ethical tools, language, and humility to approach these decisions responsibly and relationally?

To be updated shortly..