Bioethics Blogs

Critically Impaired Infants and End of Life Decision Making: Resource Allocation and Difficult Decisions

Neera Bhatia is a Lecturer at Deakin University School of Law, Australia.  She has just published Critically Impaired Infants and End of Life Decision Making: Resource Allocation and Difficult Decisions (Routledge June 2015).

Bhatia explores the legal and ethical issues surrounding decisions to withdraw or withhold life-sustaining treatment for babies born on the edge of viability (23 weeks) and addresses the controversial question, are some lives too expensive to treat?


“In western developed countries such as the UK and Australia medical practitioners are now able to keep extremely premature babies alive, but unfortunately cannot protect them from disability and lifelong poor health outcomes and the ongoing costs and impact on the families caring for these children,” 


“The main premise of my book is that the allocation of finite healthcare resources should be a serious consideration in end of life decision making for this select group of patients. With an ageing population and limited healthcare funds these difficult questions need to be asked and answered.

“I am not saying exclusively that these babies should be not kept alive, rather I am asking if we are doing the right thing by saving babies that are going to require a lifetime of ongoing health care given the fact that we have many competing priorities putting pressure on limited health care budgets.”

The book has seven chapters:

  1. Introduction 
  2. The effectiveness of the best interests principle 
  3. Non-uniformity in clinical guidelines 
  4. The role, impact and importance of key care givers and decision makers 
  5. Theories of distributive justice: Healthcare and extremely premature and critically impaired infants 
  6. Resource allocation: An objective approach in end of life decision making for extremely premature and critically impaired infants 
  7. Other observations and concluding remarks 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.