Fragile Lives with Fragile Rights: Justice for Babies Born at the Limit of Viability

10 Pages Posted: 20 Feb 2018

See all articles by Manya J. Hendriks

Manya J. Hendriks

University Hospital Zurich

John Lantos

University of Chicago

Date Written: March 2018


There is an inconsistency in the ways that doctors make clinical decisions regarding the treatment of babies born extremely prematurely. Many experts now recommend that clinical decisions about the treatment of such babies be individualized and consider many different factors. Nevertheless, many policies and practices throughout Europe and North America still appear to base decisions on gestational age alone or on gestational age as the primary factor that determines whether doctors recommend or even offer life‐sustaining neonatal intensive care treatment. These policies are well intentioned. They aim to guide doctors and parents to make decisions that are best for the baby. That is an ethically appropriate goal. But in relying so heavily on gestational age, such policies may actually do the babies a disservice by denying some babies treatment that might be beneficial and lead to intact survival. In this paper, we argue that such policies are unjust to premature babies and ought to be abolished. In their place, we propose individualized treatment decisions for premature babies. This would treat premature babies as we treat all other patients, with clinical decisions based on an individualized estimation of likelihood that treatment would be beneficial.

Keywords: end‐of‐life decision‐making, gestational age policies, justice, neonatology

Suggested Citation

Hendriks, Manya J. and Lantos, John, Fragile Lives with Fragile Rights: Justice for Babies Born at the Limit of Viability (March 2018). Bioethics, Vol. 32, Issue 3, pp. 205-214, 2018, Available at SSRN: or

Manya J. Hendriks (Contact Author)

University Hospital Zurich ( email )

Rämistrasse 100
8091 Zürich

John Lantos

University of Chicago ( email )

1101 East 58th Street
MacLean Center for Clinical Medical Ethics
Chicago, IL 60637
United States
(773) 363-3700, x 372 (Phone)

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