Moral dilemmas in neonatology as experienced by health care practitioners: a qualitative approach

During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is...

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Bibliographic Details
Published in:Medicine, health care, and philosophy health care, and philosophy, 2006-12, Vol.9 (3), p.339-347
Main Authors: van Zuuren, Florence J, van Manen, Eeke
Format: Article
Language:English
Subjects:
Attitude of Health Personnel
Bioethics
Cultural differences
Decision making
Decision Making - ethics
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases - therapy
Intensive care
Intensive Care Units, Neonatal - ethics
Interviews as Topic
Life Support Care - ethics
Medical prognosis
Morals
Neonatal care
Neonatal Nursing - ethics
Neonatology - ethics
Netherlands
Newborn babies
Nurses
Parental Consent - ethics
Philosophy, Medical
Physicians
Premature babies
Premature birth
Qualitative Research
Quality of Life
Treatment Outcome
Uncertainty
Ventilators
Withholding Treatment - ethics
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Summary:During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported - terminating an already initiated treatment - we propose the concept of 'evidence shift' to clarify the ambiguous position of uncertainty in decision making.
ISSN:1386-7423
1572-8633
DOI:10.1007/s11019-005-5641-6