Ethics in the neonatal intensive care unit: parental perceptions at four years postdischarge.

Ethical issues for the parents of neonates in neonatal intensive care units (NICUs) have not been widely researched. A multistage, qualitative project explored 23 families' perceptions of moral conflict and ethical decision making related to the NICU experience. Through in-depth interviews and the use of content analysis at 4 years postdischarge, life goes on (the major theme) and three conceptual categories were identified as characterizations of this phase. This phase, combined with two earlier phases (predischarge and 6 months postdischarge), represents a clinical manifestation of Reich's Theory of Suffering and provides a framework for understanding the parents' ethical perspective. Strategies for nurses that will facilitate parental participation in ethical decision making are presented.

Ethical perceptions of parents and nurses in NICU: the case of baby Michael.

A case was used to examine ethical challenges in the neonatal intensive care unit from the perspective of parents and nurses. Discussion focuses on issues of treatment versus nontreatment, informed consent, and decision making. An integration of crisis intervention techniques and caring processes is presented for nurses to assist parents through the neonatal intensive care unit experience.

The parents' perspective: ethical decision-making in neonatal intensive care.

Ethical debate abounds in the literature relative to treatment decisions for the high risk neonate in the intensive care nursery. A systematic examination of the parents' perspective is missing. To fill this existing gap, the ethical dimension of care was explored with 32 families of high risk newborns from a Level III nursery, using a moral conflict interview guide in order to describe their perspective. A concept of the medicalization of parenting appears to best reflect the parents' view of ethical decision-making responsibility. This concept evolved through the parents' reflection on conflict naming, content of decision-making, context of decision-making, information sharing and perception of infant status. These concerns differ profoundly from those of health professionals, philosophers, theologians and others active in this debate who cite lower limits of viability, iatrogenic effects of treatment, use of multiple invasive procedures, and the role of paternalism as ethical issues.

Ethical decision making for high-risk infants. The parents' perspective.

The experiences of 32 families with high-risk infants provide the foundation for a discussion of the parents' perception of the ethical dimension of intensive newborn care. The families' focus on the need for support in the NICU crisis rather than a plea for rights, justice, and autonomous decision making leads to a suggested professional response guided by an ethic of care. Through a caring professional, ethical decision making in the NICU can be implemented to encompass a shared moral responsibility for the high-risk infant during this process.

Parental voices in the sea of neonatal ethical dilemmas.

Ethical debate in neonatal intensive care centers around the lower limits of viability, the use of multiple invasive procedures, and the role of paternalism. The parents' perspective has been addressed infrequently. This report will focus on the parents' statements as obtained through predischarge in-depth interviews with 32 families, each with a high-risk infant(s). Discussion will include a summary of the range of parental perceptions during two major periods of time: preadmission to the NICU and the NICU experience itself. Some possible nursing implications will be drawn that reflect a sensitive response to these parental perceptions.