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


Beneficence refers to acting from a spirit of compassion and kindness to benefit others.[4] Nurses and physicians must view beneficence from the perspective of the patient and families. Parents and providers may disagree on the benefits of treatment and potential outcomes. Nonetheless, beneficence guides providers to consider and respect the viewpoints of the parents, even when those viewpoints seem at odds with provider values.[2] Consider the same example of the baby with symptomatic anemia whose parents are Jehovah's Witnesses. Although the providers recommend red blood cell transfusion for the infant, the parents decline transfusion on the basis of religious beliefs. By recommending alternative treatment options, absolute criteria for blood transfusion, and respecting the parent's beliefs, the clinicians demonstrate beneficence toward the family and simultaneously ensure the best care for the infant.

A confounding factor of beneficence and autonomy is the relative uncertainty and unpredictability of outcomes for sick neonates. Data provides a relative understanding of outcomes and expectations, but multiple individual factors determine outcomes for each neonate. Therefore, beneficence becomes a somewhat relative term from case to case.[1] A 40-week infant with persistent pulmonary hypertension of the newborn (PPHN) and Group B streptococcus pneumonia is on maximum ventilator settings with acidemia. The clinicians offer the parents the option of extracorporeal membrane oxygenation (ECMO) treatment for the infant. Although this is an indicated treatment for the infant, a favorable outcome is not guaranteed. The outcome statistics become part of the discussion with the parents. Together with providers, the parents consider all the information and treatment options in terms of the best interest of the infant. Caregivers need to support and respect parents' decisions even when disagreements sometimes arise.