'....officiously to keep alive'.

Modern medical technology has provided powerful tools with which to initiate and sustain life and understandable concern is being expressed about scientists and doctors 'playing God.' The view that 'the clinician's freedom to stop intensive treatment when the probable outcome is severe handicap is part of the package of neonatology" is far from unanimous. The hard facts are, however, that today up to 30% of deaths in a neonatal intensive care unit may follow deliberate withdrawal of life support2 and despite concern for more than a decade3 the ethics of this issue are still sub judice. The questions Who is to say that procedures such as AID (artificial insemination by donor), IVF (in vitro fertilisation), or surrogacy are right or wrong? Who knows the wisdom or folly of saving the lives of thousands, even millions, who mankind cannot, or is not prepared to feed? How long should we live 'aged and infirm'? Not the least of these weighty questions is that of the justification of termination of life support in the newborn. While some advocate preservation of life at almost any cost others believe there is a time when 'enough is enough'. But who decides? Some claim that not to try to preserve life is defeatist, denying progress, and morally wrong, yet by our interference with what might be regarded as a 'natural selection' are we creating more problems than we are solving? As with atomic energy, has society again been guilty of accepting the use of new procedures before either considering adequately the circumstances in which they should be used or the ethics of their use?4 While everyone would agree that mortality statistics should never influence the initiation, continuation, or withdrawal of medical treatment, what of family disruption, availability of resources, cost effectiveness, and even the law?5 The magnitude of these dilemmas and the interest they engender is illustrated by the fact that the whole of the June 1987 issue of Clinics in Perina-tology is devoted to ethical and legal issues in that specialty. Ethics With the exception of some forms of gross congenital deformity those attending a delivery are now obliged to resuscitate virtually all infants born around 22-24 or more weeks' gestation. The frontier for survival has crept steadily down from 1000 g to 600 g birth weight over the past 10 years, though this of course is modified by the local facilities available. It no longer …