The Colorado Collective for Medical Decisions
The Colorado Collective for Medical Decisions (CCMD) was a group of concerned health care professionals, parents, and community members across Colorado who worked together over the course of about five years (1994 to 1999) in order to create community-based guidelines that addressed medical care and end-of-life decision making. Regarding the medical care of critically ill newborns, CCMD created the Neonatal Guidelines. Our goal in developing community-based guidelines was to serve the following purposes:
¨ :: To promote open community discussion around difficult NICU medical/ethical issues in the hope that these medical resources and technology will be used wisely and humanely
¨ :: To encourage and enhance the dialogue between the parents and health care practitioners during this difficult, heart-wrenching time
¨ ::To empower physicians to be decision leaders when a baby’s prognosis is clear, whether poor or favorable
¨ :: To facilitate collaborative decision-making between health care practitioners and the parents of critically ill newborns for whom the prognosis is unclear
¨ :: To support parents emotionally, whatever decision they make for their babies
¨ :: To remind outsiders that they must be fully informed about the specific medical realities before voicing an opinion about treatment choices or attempting to represent the best interests of any infant.
CCMD NEONATAL GUIDELINES
Modern medical technology achieves many good and important goals. A primary goal of neonatal intensive care is to help sick infants become healthy children.
To use technology wisely, we must acknowledge its limitations. For some infants, the burdens of intensive care outweigh the benefits.
Parents must be fully informed about the risks, benefits, outcomes, and uncertainties of aggressive medical intervention for their individual baby. Whether an infant lives or dies, it is the parents who ultimately live with the result.
When the prognosis is clear, health care practitioners should be decision leaders.
When the prognosis is unclear (or becomes unclear), health care practitioners should work collaboratively with parents as decisions are made about an infant’s care.
When aggressive intervention is withheld or withdrawn, hospice and palliative care should be provided.
When aggressive intervention is pursued for an infant whose outcome is uncertain, physicians should discuss with parents the specific burdens of treatment and how benefits and outcomes remain speculative.
For all NICU infants, regular and timely care conferences between parents and health care teams are an integral part of providing appropriate treatment.
Follow-up care should be provided to all families.
CCMD Neonatal Guidelines regarding life-and-death decisions in the NICU:
Infants who are likely to survive should be given appropriate medical care even if they have mental or physical limitations.
Infants who are extremely unlikely to survive infancy due to extreme prematurity should receive hospice and palliative care instead of aggressive life-sustaining interventions.
Infants who are extremely unlikely to survive infancy due to a lethal birth defect should receive hospice and palliative care instead of aggressive life-sustaining interventions.
Infants for whom survival offers only a short lifetime filled with significant suffering should receive hospice and palliative care instead of life-sustaining interventions.
When the outcome of aggressive medical care for an infant is uncertain, the family should be provided with comprehensive information about aggressive medical interventions, speculative outcomes, and hospice and palliative care.
When the outcome of aggressive medical care for an infant is uncertain, decisions about life-sustaining interventions should be made jointly by the family and medical team.
Please download and distribute CCMD guidelines.
Updated: © 2011