Ethical Considerations in the Neonatal Intensive Care Unit

Lisa J. Sundean, RN, MSN, MHA; Jacqueline M. McGrath, PhD, RN, FNAP, FAAN


NAINR. 2013;13(3):117-120. 

In This Article


Sophisticated technological advances to treat the most critically ill neonates outpace clear ethical standards and approaches for NICU care. Historically, care providers have treated critically ill neonates first and reflected on the ethics of treatment later. Fortunately, ethical considerations of care are beginning to precede interventions even though no uniform approach to ethics decision-making in the NICU exists.[1] Ethical conflicts in the NICU often surround provision of treatment and withdrawal of treatment.[2] Conflicts arise from the differences in ethical perspectives of the decision-makers, whether they are physicians, nurses, parents, alone or in combination. Regardless of who the decision-makers are, ethical decisions in the NICU can have a profound effect on neonates, families, physicians, nurses, and society.[3]

The need to base ethical decisions on evidence is growing, and care providers are seeking consensus on best practices for these difficult decisions.[3] Frameworks for ethical decision-making in the NICU are available, though none are used consistently.[1] Regardless of the particular frameworks, a clear understanding of the principles of ethics provides a foundation for ethical decision-making in the NICU. Table 1 provides a summary of the four ethical principles. The four ethical principles are autonomy, beneficence, nonmaleficence, and justice; each is described below in more detail.