Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 38 (10):596-601 (2012)
Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement.
|Keywords||info:mesh/Ethics, Nursing info:mesh/Pastoral Care Humans Intensive Care, Neonatal Questionnaires Attitude of Health Personnel Interdisciplinary Communication Decision Making Pastoral Care Social Work Ethics, Medical Ethics, Nursing Adult Middle Aged Infant, Newborn Chaplaincy Service, Hospital Intensive Care Units, Neonatal Patient Care Team Netherlands Female Male info:mesh/Attitude of Health Personnel info:mesh/Middle Aged info:mesh/Decision Making info:mesh/Netherlands info:mesh/Chaplaincy Service, Hospital info:mesh/Interdisciplinary Communication info:mesh/Humans info:mesh/Adult info:mesh/Ethics, Medical info:mesh/Patient Care Team info:mesh/Intensive Care Units, Neonatal info:mesh/Intensive Care, Neonatal info:mesh/Questionnaires info:mesh/Male info:mesh/Female info:mesh/Social Work info:mesh/Infant, Newborn|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
Kath M. Melia (2004). Health Care Ethics: Lessons From Intensive Care. Sage Publications.
Kristina Orfali & Elisa Gordon (2004). Autonomy Gone Awry: A Cross-Cultural Study of Parents' Experiences in Neonatal Intensive Care Units. Theoretical Medicine and Bioethics 25 (4):329-365.
M. Davie & A. Kaiser (2007). Semi-Qualitative Study of Staff Attitudes to Care Following Decision to Withdraw Active Treatment in a Neonatal Intensive Care Unit. Clinical Ethics 2 (3):133-138.
E. J. O. Kompanje (2009). Ethical Decision-Making in Two Patients with Locked-in Syndrome on the Intensive Care Unit. Clinical Ethics 4 (2):98-101.
Thomas J. Simpson (1999). Response to “Neonatal Viability in the 1990s: Held Hostage by Technology” by Jonathan Muraskas Et Al. And “Giving 'Moral Distress' a Voice: Ethical Concerns Among Neonatal Intensive Care Unit Personnel” by Pam Hefferman and Steve Heilig. [REVIEW] Cambridge Quarterly of Healthcare Ethics 8 (4):524-526.
Anita J. Catlin & Brian S. Carter (2000). Response to “Giving 'Moral Distress' a Voice: Ethical Concerns Among Neonatal Intensive Care Unit Personnel” by Pam Hefferman and Steve Heilig and “Neonatal Viability in the 1990s: Held Hostage by Technology” by Jonathan Muraskas Et Al. [REVIEW] Cambridge Quarterly of Healthcare Ethics 9 (3):400-403.
Mark Coeckelbergh & Jessica Mesman (2007). With Hope and Imagination: Imaginative Moral Decision-Making in Neonatal Intensive Care Units. [REVIEW] Ethical Theory and Moral Practice 10 (1):3 - 21.
Carson Strong (1984). Paternalism in the Neonatal Intensive Care Unit. Theoretical Medicine and Bioethics 5 (1).
Pam Hefferman & Steve Heilig (1999). Giving “Moral Distress” a Voice: Ethical Concerns Among Neonatal Intensive Care Unit Personnel. Cambridge Quarterly of Healthcare Ethics 8 (2):173-178.
M. van Manen (2012). Technics of Touch in the Neonatal Intensive Care. Medical Humanities 38 (2):91-96.
Michael Gill, Picu Prometheus: Ethical Issues in the Treatment of Very Sick Children in Paediatric Intensive Care.
Joseph DeMarco, Douglas Powell & Douglas Stewart (2011). Best Interest of the Child: Surrogate Decision Making and the Economics of Externalities. [REVIEW] Journal of Bioethical Inquiry 8 (3):289-298.
Annie Janvier, Karen Lynn Bauer & John D. Lantos (2007). Are Newborns Morally Different From Older Children? Theoretical Medicine and Bioethics 28 (5):413-425.
David Isaacs (2011). Controversial End-of-Life Issues in the Neonatal Intensive Care Unit. American Journal of Bioethics 11 (2):43 - 44.
Hanne Irene Jensen, Jette Ammentorp, Helle Johannessen & Helle Ørding (2013). Challenges in End-of-Life Decisions in the Intensive Care Unit: An Ethical Perspective. [REVIEW] Journal of Bioethical Inquiry 10 (1):93-101.
Added to index2012-05-26
Total downloads12 ( #299,688 of 1,911,325 )
Recent downloads (6 months)1 ( #455,910 of 1,911,325 )
How can I increase my downloads?