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A framework for ethical decision making in neonatal intensive care
Author(s) -
Baumannhölzle Ruth,
Maffezzoni Marco,
Ulrich Bucher Hans
Publication year - 2005
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2005.tb01853.x
Subject(s) - medicine , interquartile range , intensive care , teamwork , neonatal intensive care unit , intensive care unit , intensive care medicine , psychological intervention , critically ill , ethical decision , nursing , pediatrics , psychology , surgery , political science , law , social psychology
Intensive care for neonates with high risks of severe impairment and the possibility of a prolonged dying process represents a frequent ethical issue in neonatal units. The aim of this paper is to present a framework for structured decision making that has been developed in a neonatal intensive care unit and to demonstrate its impact on the healthcare team and on survival of critically ill neonates. This framework attempts to integrate the best interests of the infants and their parents, the possibilities of high‐tech neonatal intensive care interventions, and the perspective of the nurses and doctors. An external evaluation of 84 sessions over 3 y revealed a beneficial effect on the quality of the decision‐making process itself and on the quality of the teamwork in the unit. Survival time was shorter (median 2 d, interquartile range 1–7 d) in 26 infants that died after structured decision making compared with 26 controls matched for gestational age, malformation and intracranial haemorrhage (median 7 d, interquartile range 4–15 d). Conclusion: The introduction of this framework for structured decision making involving doctors and nurses improved the quality of the teamwork. It shortened futile intensive care, and thereby suffering for both infants and parents.