COMMENTARY

Get Real: No Need to Overdo Risk Disclosure

Arthur L. Caplan, PhD

Disclosures

June 11, 2013

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Hi. I am Art Caplan, from the NYU Langone Medical Center. I am head of the Division of Medical Ethics there.

Is it possible that ethicists could actually make a mistake? I know that this is difficult for anyone to believe, but I think a big mistake has just been made, a mistake that could truly harm premature babies, their parents, and potentially a lot more that is going on in healthcare today.

A study led by neonatologists at University of Alabama, Birmingham, aimed to understand what amount of oxygen to give to premature babies who, because their lungs are poorly developed, need help with breathing. Many, many years ago, doctors attempted to help these preemies by giving oxygen, but they did not realize that too much would induce blindness in these babies. Because of this, we had a terrible, sad discovery that in trying to do good, many premature infants were blinded.

Today we have narrowed the range at which oxygen is given to premature babies, but we still do not know exactly what percentage is the best. The range is between 85% and 92% oxygen saturation, but it is left to the individual doctor to decide the level within that range. There is still some risk of blinding, and if you do not get enough oxygen, there is a risk that the baby will die. These are frail babies anyway, so you are trying to treat them against a high-risk environment to begin with. The SUPPORT study[1] was designed to see whether 85% oxygen is better or worse than 92%.

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