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


Justice refers to acting out of fairness for individuals, groups, organizations, and communities.[4] Providers often question the principle of justice when confronted with infants of parents with different values and lifestyles. When a preterm infant dies following years of infertility treatment for parents who desperately want a child and in the same NICU, a preterm infant suffers from crack withdrawal from a crack-addicted mother, providers are conflicted and question the ethical principle of justice. Regardless of the circumstances, nurses and physicians must provide compassionate, quality care to both infants and treat both families with dignity.

Justice also refers to fair allocation of services and resources. In a global sense, ethical conflicts arise when considering the ability to offer life-saving NICU services to an infant in one country, but the inability to offer the same services to a similar infant in another country. The limits of resources create ethical conflicts of justice.[1,2] Similarly, economic goals of health care organizations sometimes conflict with the goals of care and treatment.[4] For example, NICUs are typically revenue-generators for hospitals with high third party reimbursement rates for NICU care. Allocation of funds to expand NICUs to reach organizational economic goals without consideration of the goals of neonatal care and the needs in the community is unethical under the principle of justice.[1] However, allocating funds for NICUs to provide equal and adequate access to necessary care that does not exploit community and organizational economic goals shows respect for the ethical principle of justice.