Aspectos éticos relacionados con las decisiones clínicas en neonatología: estudio preliminar / Ethical features related to clinical decisions in neonatology: prliminary report

RESUMO

Background: Personnel working in neonatal intensive care units frequently face difficult ethical problems related to the initation, maintenance or withdrawal of life support therapies. Aim: To assess the importance of ethical issues in the clinical decision making of health care providers in neonatal intensive care units. Material and methods: A questionnaire based on five clinical vignettes that assessed judgments about quality of life, impact of parent's opinions and decision making in emergency situations and with different degrees, of certainty, was designed. Eleven neonatologists and 20 nurses and midwives specialized in neonatology anonymously answered this questionnaire. Results: There was a great inter individual variability in therapeutic approaches in cases with a bad vital and neurological prognosis. In cases of medical emergencies with uncentain diagnoses, bad vital prognosis but neurological indemnity, most professionals coincided in delivering all possible therapeutic options. Parent's opinions had a great impact in medical decisions, except when there was neurological indemnity. Conclusions: The specific responsibilities of the different agents in medical decision making must be delimited. Parents do not have absolute rights over their offspring and physicians must reject useless therapies