Historical Overview of New Ethical issues for Neonatologists in 2026: Challenge and Perspectives

Abstract

Since the 1960s, neonatologists have been caring for newborns, primarily premature infants, but also sick term babies whose vital prognosis is at stake. In the 1970s, newborns in French critical care units benefited from technical advancements inherited from adult patient resuscitation. By the 1980s, ethical considerations emerged regarding the present and future quality of life for newborns: is everything technically possible and acceptable? In the 1990s, collaboration between neonatology professionals and partnerships with families helped establish guidelines for the proportionality of care and the cessation of intensive treatments. The practices of expectant resuscitation and withdrawal of life support began to disappear. The laws of 2005 and 2016, drafted from clinical situations of adult patients, provided neonatologists with new frameworks to legitimize their actions, particularly in situations requiring deep and continuous sedation-analgesia maintained until death and the cessation of artificial nutrition and hydration. The physician remains the decision-maker, although parents bring experiential knowledge. Neonatologists must also encourage teams trained in technical support procedures to receive training in palliative care and to accompany the newborn and their family best.