Editorial: Palliative and end of life care in the NICU issue I.

It has been fifty years since Duff and Campbell's seminal article in the New England Journal of Medicine entitled “Moral and Ethical Dilemmas in the Special Care Nursery.” [ [1] Duff R.S. Campbell A.G.M. Moral and ethical dilemmas in the special-care nursery. N Engl J Med. 1973; 289: 890-894 Crossref PubMed Google Scholar ] In 1973, those authors described the circumstances surrounding 299 consecutive newborn deaths at Yale New Haven Hospital, in what is said to be the first modern newborn intensive care unit (NICU) in the United States. The authors drew a great deal of attention and controversy, because they were among the first to publicly acknowledge that many newborn deaths were the immediate result of decisions, reached by physicians and parents working together, to withdraw or withhold available technology. In some circumstances, they argued, this was the best solution when faced with infant patients likely to die, or to survive with profound disabilities. Not everyone agreed, to be sure, though in the following decades it became evident that death in NICUs commonly occurred in the setting of withdrawal or withholding of critical care measures. The hard ethical work, of course, was and is determining whether and when withdrawal should occur, and who should make such decisions.