Professional ethics: the case of neonatology

Stanak, Michal

doi:10.1007/s11019-018-9863-9

Cited by 9 publications

(16 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Beyond that, ethics committees can help the team navigate communication with parents while understanding that the parents have ultimate responsibility of acting as moral agents for their baby (61). It is only with the recognition of the moral and ethical dilemmas unique to the NICU that organizational support for establishing ethical framework to support complex decision-making can truly come to fruition (62). With this support and structure in place, there can be improved quality of care through less conflict and distress amongst team members.…”

Section: Role Of Ethics Consultationmentioning

confidence: 99%

Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It

Mills

Cortezzo

2020

Front. Pediatr.

View full text Add to dashboard Cite

Moral distress is prevalent in the neonatal intensive care unit (NICU), where decisions regarding end-of-life care, periviable resuscitation, and medical futility are common. Due to its origins in the nursing literature, moral distress has primarily been reported among bedside nurses in relation to the hierarchy of the medical team. However, it is increasingly recognized that moral distress may exist in different forms than initially described and that healthcare professions outside of nursing experience it. Advances in medical technology have allowed the smallest, sickest neonates to survive. The treatment for critically ill infants is no longer simply limited by the capability of medical technology but also by moral and ethical boundaries of what is right for a given child and family. Shared decision-making and the zone of parental discretion can inform and challenge the medical team to balance the complexities of patient autonomy against harm and suffering. Limited ability to prognosticate and uncertainty in outcomes add to the challenges faced with ethical dilemmas. While this does not necessarily equate to moral distress, subjective views of quality of life and personal values in these situations can lead to moral distress if the plans of care and the validity of each path are not fully explored. Differences in opinions and approaches between members of the medical team can strain relationships and affect each individual differently. It is unclear how the various types of moral distress uniquely impact each profession and their role in the distinctively challenging decisions made in the NICU environment. The purpose of this review is to describe moral distress and the situations that give rise to it in the NICU, ways in which various members of the medical team experience it, how it impacts care delivery, and approaches to address it.

show abstract

Section: Role Of Ethics Consultationmentioning

confidence: 99%

Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It

Mills

Cortezzo

2020

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…Another key moral challenge stems from the ambiguity about the best interest of the EP infant (Stanak 2018 ). Because deciding in the grey zone of gestation is a matter of surrogate decision-making the rightness or wrongness of which cannot be verified with the EP infant until considerably later, the question of surrogate consent and the connected question of best interest are at stake.…”

Section: Explicit Moral Challenges In the Neonatal Practicementioning

confidence: 99%

“…They need to make judgments that are concerned with rightness and wrongness that stand separate to their clinical decisions. This constitutes the moral sphere of their profession (Stanak 2018 ). For instance, in communication with parents, they need to make judgments about the threshold QoL of the EP infant and hence its best interest.…”

Section: Analysis Of Nudging In Nicus: Definitions and Moral Challengmentioning

confidence: 99%

“…I want to further argue that there is a need to recognize the role of ethics in the NICU profession more not only because of the theoretical argument above, but also because of the practical argument that recognizing the role of ethics leads to better care for infants (Stanak 2018 ). It is the case because of two reasons.…”

Section: Analysis Of Nudging In Nicus: Definitions and Moral Challengmentioning

confidence: 99%

“…The virtues we are concerned with are both intellectual and moral. I have argued elsewhere that intellectual virtues in the neonatal context concern the virtues of episteme and phronesis and moral virtues include the virtues of courage, compassion, fidelity to trust , and integrity (Stanak 2018 ). What distinguishes these moral virtues from mere character traits is their commitment to goodness (Annas 2011 ).…”

Section: Virtue Ethics Solutionmentioning

confidence: 99%

See 2 more Smart Citations

Neonatology in Austria: ethics to improve practice

Stanak

2020

Med Health Care and Philos

Self Cite

View full text Add to dashboard Cite

In the world of Austrian neonatal intensive care units, the role of ethics is recognized only partially. The normatively tense cases that are at the backdrop of this essay concern the situations around the limit of viability (weeks 22 + 0 days to 25 + 6 days of gestation), which is the point in the development of an extremely preterm infant at which there are chances of extra-uterine survival. This essay first outlines the key explicit ethical challenges that are mainly concerned with notions of uncertainty and best interest. Then, it attempts to elucidate the less explicit ethical challenges related to the notion of nudging in the neonatal practice and argue that the role of ethics needs to be recognized more-with the focus on the role of virtue ethics-in order to improve the practice of neonatal medicine.

show abstract