Dr Kumar raises difficult questions. How does one protect the interests of an infant when so many other interests and preferences are in play? How does one define those interests and resolve disagreements about treatment?

First we must point out how the “Ethics Rounds” articles work: actual cases are constructed, with facts changed to protect confidentiality, and sent to commentators in stages. Commentators do not know the outcome of the case and are asked, “What would you do, given what you know now?” Only after they have responded do they learn what happened next. They do not see each other's responses until all of them have been compiled.

In this case, as in many cases that involve infants with trisomy 18, the doctors strongly recommended palliative care. The parents considered that recommendation but chose not to accept it. Instead, they requested life-prolonging treatment. Often, when doctors recommend palliative care, parents...

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