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In neonatal intensive care units, the medical team may be led to question itself about whether to continue, withhold, or withdraw a newborn’s life-sustaining treatment. The child’s brain damage and the disability that can result from it must be taken into account in order to evaluate his or her future quality of life. Due to its ethical complexity, the end-of-life decision must be made in staff meetings— allowing each involved caregiver to express and argue his or her own point of view—and as part of a genuine dialogue with the parents. This kind of decision is guided by a main principle: the child’s “best interests.” This article questions this principle in connection with the concept of “future quality of life.” We recall the definition of the principle, while identifying its conceptual ambivalence. We also highlight the difficulties faced by caregivers and parents when it comes to determining it and to assessing the child’s future quality of life. The very close link between quality and value of life raises major ethical questions. Given these difficulties, it seems clear that the “best interests” principle does not have a substantial definition, only the procedural way makes it possible to approach it, in the search for a compromise between healthcare professionals and parents. Thus, the “best interests” cannot be considered as a truly operational criterion: it is rather an ideal to be attained or a “compass” capable of guiding the decision-making process in neonatology.