Biomedical Ethics in Neonatal Care

Forouzan Akrami

MPH of Social Determinants of Health

PhD by Research Candidate (Bioethics)

Medical Ethics and Law Research Center ,

Shahid Beheshti University of Medical Sciences

ethical decision making ?why ?

biomedical ethics involves the systematic,

reasoned evaluation and justification of the "right"

action in pursuit of human good or well-being in

the context of medical practice.

specific moral problems in field of neonatal care

(1) when a pregnant patient refuses treatment,

(2) in the prenatal consultation at the limits of viability, and

(3) When withholding and withdrawing life-sustaining medical treatment in the neonatal intensive care unit (NICU) is undertaken.

The NICU a challenging, highly scrutinized environment

Ethical issues may be experienced moral dilemmas,moral uncertainty, moral distress,

Biomedical ethics principles in the care of newborns

autonomy,beneficence, Non maleficence, justice

Key Concepts (NICU) Respecting parental authority/autonomy

Applying the best interests of the infant standard of judgment

Minimizing harm to the newborn

Developing sound parent-physician relationships

Empowering and informing parents

Applying family-centered care principles

Respecting parents' values and cultural and religious beliefs

Sharing decision making

Developing respectful inter professional (moral) teamwork

Moral distress

انجمن آمریک�ایی پرس�تاران مراقبت ه�ای وی�ژه در ی�ک بیانی�ه در س�ال اهمیت تنی�دگی اخالقی در حرف�ه پرس�تاری را تش�خیص داده و 2008

ی�ک اظهاری�ه خ�ط مش�ی عم�ومی در جهت مقابل�ه ب�ا ش�واهدی ک�ه نش�انگر ت�أثیر منفی آن ب�ر محی�ط م�راقبت بهداش�تی و حف�ظ نظم

پرستاران بوده تدوین کرد.

این انجمن اظه�ار می� دارد ک�ه تنی�دگی اخالقی ی�ک مش�کل بح�رانی درمحی�ط ک�اری پرس�تاران می باش�د ک�ه اغلب هم از آن غفلت می ش�ود و اگ��ر م��ورد توج��ه ق��رار نگ��یرد توان��ایی پرس��تاران را ب��رای ت��أمین

مراقبت بهینه و بدست آوردن رضایت شغلی محدود می سازد. . AACN: American Association of Critical-Care Nurses

( در ارای�ه نظری�ه تنی�دگی اخالقی خ�ود اظه�ار نم�وده 2002کورلی ):است

اه�داف پرس�تاری اخالقی هس�تند، وق�تی دس�تیابی ب�ه این اه�داف مث�ل حف�اظت از آس�یب ب�ه بیم�اران، ارائ�ه م�راقبت شایس�ته و ب�ه موق�ع و حف�ظ محی�ط س�الم ب�ا م�انع مواج�ه ش�ود، پرس�تاران از تنی�دگی اخالقی

رنج می برند.

ناک�افی کارکن�ان تع�داد ک�ه اس�ت زم�انی اخالقی تنی�دگی او نظ�ر به اس�ت، سیاس�ت ها و دس�تورالعمل های س�ازمانی ط�وری اس�ت ک�ه ت�أمین ممکن غ�یر ح�تی ی�ا دش�وار را آن�ان خانواده�ای و بیم�اران نیازه�ای

می کند.

Criteria for Withholding and WithdrawingLife-Sustaining Medical Treatmentin the Neonatal Intensive Care Unit

1. Inevitability of death. This is a situation where it is likely that the infant would die whether intensive care is continued or not. At minimum, the infant would likely not survive to discharge from intensive care.

2. Ineffective treatment. Treatment that is not meeting or would not meet the goals set for that treatment is considered ineffective.

3. Poor quality of life. Despite the difficulty in determining the quality of a life with limited cognitive or relational capacity, mobility, or self-awareness, or a life of continued pain and suffering, a poor quality of life is a valid consideration as to whether treatment should be initiated or continued in the face of an extremely poor predicted outcome.

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Thanks for your attention