End-of-life care and orthothanasia in the neonatal ICU: ethical and legal aspects

Abstract

Introduction: Technological advances in neonatology have expanded viability limits but intensified dilemmas regarding therapeutic obstinacy and dysthanasia. Objective: To analyze end-of-life care in the Neonatal Intensive Care Unit (NICU) from the perspectives of legal certainty, clinical bioethics, and the role of mediating communication. Data source: Normative and bibliographic review (PubMed, SciELO, SBP manuals, and CFM resolutions) covering the 2000-2025 period. Data synthesis: Defensive medicine and the moral distress of healthcare teams, exacerbated by the lack of Clinical Bioethics Committees in Brazil, drive the maintenance of futile life support. Communication protocols (SPIKES and PACIENTE) and the redirection of therapeutic efforts, supported by CFM Resolution No. 1,805/2006 and the constitutional principle of human dignity, are essential to align the “Best Interest of the Child” with orthothanasia. Medico-legal backing rests on documentary transparency and the disruption of the causal link through the diagnosis of irreversibility. Conclusions: The pediatrician’s legal certainty is grounded in shared decision-making and detailed medical record documentation. Strengthening institutional frameworks and palliative care training is imperative to ensure the dignity of dying and the professional’s full ethical-legal protection.