Analysis_of_Ethical_Dilemma

Analysis of Ethical Dilemma from Current Events Britteny Baxter NRS 437V Grand Canyon University Ethical Decision Making in Health Care June 12, 2011 An Ethical Dilemma in Neonatal Care Ethical dilemmas in the health care setting, such as neonatal intensive care unit (NICU) present themselves daily. It is imperative that the health care worker be able to understand when an ethical dilemma presents itself and know how to deal with the dilemma in the best interest of all involved. For this paper, ethics are defined as “the applied philosophical study of right actions or how healthcare professionals may struggle to do what is right or good for their patients” (medscape). Many ethical dilemmas that health care workers face are difficult. There is no easy fix and often the result is upsetting. Occasionally, an ethical committee is needed to offer solutions and direction.       The article published in 2011 by Pediatrics: Cardiac Disease and Critical Care Medicine, titled “Ethical Issues in Neonatal Care” will be analyzed according to Uustal’s decision-making model. This paper will also address primary ethical issues raised in neonatal medicine and caring for critically ill newborns. Personal values and ethical theories will be addressed and applied as well as how the situation may be handled differently. Ethical Problem For more than forty years, neonatal medicine has provided specialized and intensive care measure aimed at improving health and survival of premature and critically ill newborns. At this time in society, the result of the progress is mixed. There is a substantial decline in the mortality of premature infants and handicap but significant morbidity remained steady of near all gestational ages and weights. Despite this information, “the rate of prematurity or low birth weight babies has not declined in the United States; in fact it has risen” (medscape). Furthermore, the rate of birth defects remains constant and infant mortality remains higher in the United States than in many other developed nations. Unfortunately these babies are at great risk for cerebral palsy, hydrocephalus, neuro-developmental delay, and hearing and vision problems.   Predicting outcomes in the first days of life is difficult and creates a dilemma of how to decide treatment when not knowing what the future will hold for the infant. Frequent questions about ethical issues in neonatal care are listed: “What are the goals NICU'”; “What place do guidelines have in the ethical practice of neonatal medicine and how should they be developed'”; “What is good for critically ill newborns and who determines this'” (medscape). My Value and Ethical Position I believe every situation is unique. When there is a significant chance for healthy survival, then continuing medical intervention and treatment is unquestionably best for the baby. Likewise, when the prognosis is clearly poor, it is reasonable for physicians to gently inform the parents that medical intervention would hold no benefit for the baby. In both of these situations, the way to go is clear. Then there is the gray area, where the best option isn't clear, and these difficult decisions require thoughtful, heartfelt judgments by the parents and healthcare team. Difficult decisions require delicate judgments, and no line should be drawn in an attempt to make these decisions easy. They will never be easy. I also believe when the prognosis or treatment outcomes are uncertain, and questions such as these arise: "Do we resuscitate or not'" or "Do we continue artificial life support or not'" parents should be the primary decision-makers. When informed and given time to ponder the realities, they are in the best position to decide which path they and their baby should go down. My value of being compassionate, loving, hopeful, honest, faithful, motivated, knowledgeable, and professional started forming at a young age and continues guiding my positions on ethical topic such as this one. I feel that if there is a chance at all to save a life we owe it to the patient and family to do so, and I believe that is the goal of the NICU. It is also our responsibility to educate the public on topics such as: reasons for prematurity, low birth weight, birth defects, and common medical diagnosis that hinder an infant’s life. This education must start when the woman is told she is pregnant and must continue throughout the entire pregnancy. In this particular situation my personal feelings and beliefs were shaped by the virtue and casuist theory. The virtue theory asks what a "good person" would do in specific real-life situations and casuist theory if possible compares a current ethical dilemma with examples of similar ethical dilemmas and their outcomes. Alternatives When addressing the alternative goals of the NICU they should be centered on the baby and family. Health care professionals and parents must come together to decide the goal of the unit such as “to save all babies” or “reduce infant mortality”. It’s the family that must live with the long-tem consequence of the decision when deciding if the baby is treated or not treated. Goals of the unit also include: most advanced critical care technology, multiple lab measurements, and the provision of skilled professionals. The unit’s goal for the baby would be an expectation of steady improvement and develop care so that one could enjoy and participate in a prolonged life beyond infancy.