Swedish Medical Ethical Council Recommends Against Resuscitation for Infants Born Before 23 Weeks

The Swedish Medical Ethical Council (Smer) has issued new recommendations advising medical professionals to stop active resuscitation efforts for infants born before 23 weeks gestation. Instead, palliative care should be provided, except in special cases such as uncertainty about gestational age or the infant's size. This significant shift comes after criticism of Sweden's aggressive treatment of extremely premature infants, including those born at 22 weeks, which is below the legal abortion threshold.

Anders Castor, pediatrician and expert at Smer, highlighted that for most infants born this early, the risks of active intervention outweigh the benefits. Current survival rates for babies born before 24 weeks are approximately 50%, but many survivors face serious disabilities. The council’s recommendation also emphasizes enhanced involvement of parents in decisions regarding their infants' care—a change welcomed by professionals like Ulrika Ådén from Karolinska University Hospital.

Following these recommendations, Smer has called upon the Swedish government to instruct the National Board of Health and Welfare to create comprehensive national guidelines to ensure consistent practices across neonatal care units.

Sweden's prior approach has been notable for aggressive treatment of these extremely premature infants, a stance that has provoked ethical debate and public scrutiny, especially after the investigative documentary “Mirakelbarnen” by Uppdrag granskning highlighted these practices. The new guidelines mark a pivotal moment in Swedish neonatal care policy, potentially aligning medical practice more closely with considerations about viability, quality of life, and ethical responsibility.

The council’s recommendation advocates a cautious and ethically informed approach, reflecting the complex balance between survival chances and the potential for disability, while acknowledging the crucial role of parental input to accommodate individual circumstances.