To the Editor.

McGraw and Perlman are to be commended for exploring this issue. I agree that a possible explanation for the changing attitude may partly be related to the observation that support for the best-interest standard for neonates is diminishing in favor of parental autonomy. I would contend, however, that in certain circumstances, more intensive intervention can meet both the best-interest-of-the-child standard and the futility-of-care standard.

For trisomy 18, studies have shown that 5% to 10% survive the first year. Perhaps this low degree of survivability could be called “lethal,” but I believe using this term may carry a bias, perhaps unintended, when presenting information to a parent. It is not uniformly lethal, and I think that other terminology should be used that is more accurate. Survivors do have severe neurologic and physical impairment. It is important to note, however, that they do make milestones, albeit...