Giving “Moral Distress” a Voice: Ethical Concerns among Neonatal Intensive Care Unit Personnel

Abstract

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the “gray area” gestation period of approximately 23–25 weeks may result in situations where various people involved in such cases may feel “held hostage” to technological imperatives. Legal decisions and standards have evolved that are discordant with the views of many clinicians most familiar with the treatment of such patients. Increasing concerns regarding such scenarios have fueled much academic and professional debate about the need for consensus about ethical limits to clinical interventions with high probability of nonbeneficial impact. While at least some clinicians and ethicists may be inching toward consensus regarding limits to such treatment, the voices of some bedside personnel, particularly neonatal intensive care unit (NICU) nurses, have been relatively muted in this debate. At least one previous survey of clinicians, which included nurses, indicated that many nurses experienced a high level of “moral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of futility.