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


Consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice in the NICU is imperative as capabilities and technology advances. The ability to provide life-saving technologies to smaller, sicker, and younger neonates outpaces ethical standards for care in the NICU. Although providers and ethical experts recognize the need to move ethical discussions to the forefront of care in the NICU, no standard framework exists for these discussions. Experts do believe an evidence-based, family-focused approach is the best approach for resolving ethical conflicts in the NICU.

The principle of autonomy urges providers to respect the cultural and ethical beliefs of parents in making care decisions in the best interests of their baby. By providing parents with evidence-based information and respecting their decisions to act in the best interests of their baby, providers can work collaboratively with families to honor the principle of beneficence.

The technology of care in the NICU often confronts the principle of nonmaleficence. When considering nonmaleficence, providers and parents must weigh the goals of care against outcome expectations and commit to reducing iatrogenic harm to neonates in the NICU. Respect for the principle of justice in the NICU is evident when allocation of funds reflects true community needs and the goals of care are not simply the economic goals of the hospital.

Ethical practice recommendations in the NICU include understanding personal ethical beliefs and values, and understanding differing ethical beliefs and values based on culture. Understanding the principles of ethics in combination with current clinical knowledge, professional guidelines, national standards, and laws helps providers offer families broad and holistic information for ethical-decision making. Disclosing information to families in a way that is culturally sensitive and family-centered ensures families the opportunity to make ethical decisions in the best interests of their babies. Debriefing sessions for staff following challenging ethical issues offers opportunities for support, learning, and guiding future ethical decision-making processes. The development and use of ethics committees comprised of all stakeholders including families offers advice and guidance for ethical decision-making in the NICU.

Care provision in the NICU is highly technical and stretches the limits of ethics. To engage in effective communication and ethical decision-making in the NICU, clinicians must address ethical beliefs and values with and between themselves, and understand the cultural ethical beliefs and values of patient families. In addition, clinicians must comply with professional and legal ethical standards of care. Solid understanding of the ethical principles of autonomy, beneficence, nonmaleficence, and justice in combination with providing current evidence-based neonatal care help guide nurses and physicians proactively when ethical conflicts arise in the NICU.

Ethical principles in combination with professional and legal practice guidelines provide an ethical framework for the highly technical and often ethically ambiguous NICU environment. Providers in the NICU must continually question and consider ethical principles when providing care to neonates because the technology of care is not always congruent with the ethics of NICU care and can have long-lasting effects on patients, family, providers, and society. Understanding ethical principles and abiding by ethical best practices helps neonatal nurses and physicians provide compassionate family-centered care with ethical forethought in the highly technical NICU environment.