In this paper, I have described all sides of neonatal ethics and have presented my view regarding the topic. I have also managed to integrate philosophical and historical perspectives regarding neonatal care and ethics. In the end, I have given my personal opinion concerning the solution of the issues at stake. The ethical debate regarding the proper care of severely unwell infants is one of the oldest debates in medical sciences. In the present times, approaches that are extremely unusual have been taken to decide about the care of such newborns.
This is the reason why it is exceedingly important to analyze the ethical concepts and arguments about many issues concerning the neonatal medicine. Such ethical debates revolve around “the value of human life; the role of best interests; the deliberate ending of life; and the withholding and withdrawing of treatment” (Brazier). It is a known fact that mankind has been facing ethical concerns since the dawn of civilization. As far as clinical situations are concerned, physicians also face ethical questions on a regular basis regarding one case or the other. However, those involved in neonatal care face a lot of ethical controversies.
It is not an untold secret that ethical and moral issues regarding the treatment of neonates have penetrated into a number of features of such cases (Pueschel). When the newborns are within the first 28 days of their lives, they are known as neonates. As far as neonatal intensive care units are concerned, they frequently accommodate and look after for babies who fall in any of the three categories i. e. babies born premature having birth weight that is very low, babies born after nine months (full-term babies) having severe conditions or babies born with inherited abnormalities (“Bioethical Issues – Neonatal Ethics”).
However tremendous changes have taken place in the modern times and it is now more than five decades that “neonatal medicine has been practiced to provide specialized and intensive care measures aimed at improving the health and survival of premature and critically ill newborns” (Carter). In the contemporary world, the ethical issues generally revolve around the decision making for the betterment of neonates. Such decisions entail the consideration and evaluation of treatment and assessing whether it would be helpful or ineffective for the wellbeing of the little individual.
Thus both short-term and long-term scenarios related to the health of the child are considered while taking any certain decision. The two issues that are of main concern in the process of decision making are the likelihood to survive therapeutic/remedial involvement and the quality of life in the future. It is important here to mention the most renowned case of neonatal decision-making regarding Baby Doe. The child was born with Down’s syndrome and a tracheal-esophageal fistula in 1982. The parents opted for the hard choice and agreed to not repair the fistula with surgical intervention.
They decided so because it was in the best interest of the child. They did not want their child to continue living a depended and quality-lacking life given by Down’s syndrome. In the end, starvation ultimately took Baby Doe’s life (“Bioethical Issues – Neonatal Ethics”). When neonatal context is discussed, decision making in this regard is rather multifaceted and difficult. The parents of seriously ill neonates have to consult with the care providers and in most of the cases, have to make decisions concerning the newborns’ life-and-death treatment.
It is too difficult to decide about the fate of a child who is being awaited for so long. At the same time as it is burdensome for parents to decide the outcome of their child’s life, parents are put in a difficult position to decide so with no clear decision-making process. As a consequence, parents are often given assistance by providers and make illogical, stress-laden and uninformed choices that are not based on systematic analysis but on intuition. As a matter of fact, majority of the opted methods do “correspond with what is in the best interests of their newborn” (Panicola 723).
On the other hand, in few cases, the decisions made by parents result in non-treatment decisions for babies who must be given a chance for survival and treatment decisions for neonates who must not be given a chance to survive due to their extremely poor physical condition (Panicola 723). There may be mandatory, elective or ineffective treatment based on the neonatal cases’ unique aspects. However, the physicians and parents decide to continue with a particular kind of treatment after observing the prognosis of a newborn. If the prognosis looks good, they eventually decide for medical intervention necessary to keep the newborn alive.
On the other hand, there are a number of cases where parents refuse to involve medical intercession for the treatment of their child. In such occasional circumstances, hospitals take the help of their ethicists for seeking a court order so that the decisions of the parents may be made ineffective and treatment can be initiated for the betterment of the newborn. The situation turns out to be more notorious when there is no adequate knowledge regarding the prognosis of a neonate and the parents are given the choice to discuss their options about the treatment with the physician (“Bioethical Issues – Neonatal Ethics”).
Thus, it is when bioethics comes into scene that deals with the limitations, commitments and responsibilities of all the people who are a major part of the decision-making progress. As a final point, there are also a number of cases when medical intervention is considered pointless and unsuccessful, nevertheless the doctors and parents insist to treat the newborn. In such circumstances, treatment is regarded as tremendously troublesome and tentative thereby pointing out that there are small chances of surviving treatment with quality of life in the least.
As far as bioethics evaluation is concerned, it considers the patient rights, parental rights and physician duties and responsibilities (“Bioethical Issues – Neonatal Ethics”). It is important to mention here that in the last four to five decades, there has been a momentous development in the technology, skills and medicinal/therapeutic interventions in the neonatal intensive care unit (“Bioethical Issues – Neonatal Ethics”). Also, technical capabilities have been improved drastically allowing more speedy and accurate diagnosis, efficient scrutiny and supervision and unambiguous treatment.
Special-care nursery beds are now available in large numbers and the number of important people including the professionals and specialists has also increased for the successful treatment of God’s susceptible population (Carter). Although such a notable development in neonatal care has brought up stories of joy and miraculous recovery of the newborn, there have been depressing and painful stories where the newborns ended up with severe disabilities (“Bioethical Issues – Neonatal Ethics”).
As a consequence, bioethics can be helpful and facilitate both physicians and parents in solving issues related to the “regulation on use of experimental technological developments and by providing guidance in controversial situations” (“Bioethical Issues – Neonatal Ethics”). If the pages of the past are turned, it is rather obvious that the percentage of premature babies who managed to survive was very low. However, in the last three decades, the advancements in technologies and medical developments at the beginning of life have totally revolutionized the likability of babies’ survival that born before 28 weeks of gestation.
In the current times, it has been recorded that in developed countries like United Kingdom, more than eighty percent pre-mature babies manage to survive and a good number of the little creatures even survive at gestation period of just twenty-three weeks. Such advancements and developments are rather exciting. However, at the same time, concerns have raised regarding the human and financial cost of such progressions in the care of neonates. According to the research, more or less twenty percent of the survivors who were born extremely premature have ninety-nine percent chances of having disabilities like cerebral palsy.
A majority of such survivors are also likely to be challenged with academic and behavioral problems once they are in schools (Wyatt 1). Therefore, a lot of people are concerned whether attempts to save the life of such weak neonates is a sensible utilization of resources or not. Another contradiction in this regard is that even as huge investments are made for making it possible for a newborn to survive, the abortion of fetuses is also tolerated for social reasons.
Thus, as far as ethical dilemmas are concerned, they are not only raised by the premature babies but also by babies who have grave complicated congenital malformations at the time of birth. These malformations may be in heart, nervous system, brain, lungs etc. Thus, the ethical concerns regarding neonatal care is that whether such babies must be treated or medical intervention be withheld? (Wyatt 1). As far as the historical perspective and philosophies regarding the issue of neonatal care is concerned, a number of different societies all over the world have considered newborn babies as being less valuable when compared with the adults.
In Greek and Roman societies, infanticide i. e. the deliberate killings of newborns and the exposure of infants was a practice that was acknowledged commonly and practiced far and wide. As the mentioned societies characterized themselves for athleticism, power and strength so it was not a surprising thing that those people looked down on and hated babies who were weak, dependent and immature. Thus, an individual child was given importance on the basis of his likable future contributions to the society as a mature adult. Regrettably, no rules and regulations and laws were there that prohibited people from murdering the helpless and ill babies.
Sorry to say, in some cases, even the newborn babies who were in good physical health did not have protection by social custom or lawful decrees. It is a bitter reality that killing of malformed babies was considered important for the maintenance of the quality of the civilians. Similar practices were also common in some parts of the Eastern world (Wyatt 1). As far as the secular perspective in this regard is concerned, a number of contemporary philosophers today have accepted the fact that unwanted babies were killed or allowed to die and it was not an abnormal practice in many of the societies in the historical times and societies.
It is also claimed that even today people do not consider the murdering of unwanted babies as unethical and this is evident from the fact that prenatal diagnosis and abortion for fetal abnormality is now accepted by a lot of people and societies. Thus, this acceptance crystal clearly demonstrates that even the modern societies of today value the life of a child on his/her physical strength and healthiness and his/her prospected future contributions as an adult citizen for the society (Wyatt 2).
Neonatal care raises a number of ethical issues including the deserving neonates who must be given prenatal and neonatal specialty care, the person/group responsible for paying for the care, whether neonatal intensive care costs are acceptable or not, the assurance and equitable distribution of the care, whether babies require intensive care or not, the burdensome consequences of neonatal intensive care, the decision-maker and on what basis decisions are made. These mentioned issues create dilemmas for the healthcare professionals as they obstruct the process of provision of neonatal intensive care.
To some extent, these ethical issues concerning neonatal care throw light on the values of the healthcare professions, patients, parents and families. It is important to mention that that these issues are not to be ignores as the failure to acknowledge them may devalue the cultural influences that may shape up a society and human interactions. As already mentioned, neonatal medicinal advancements have provided more options to the physicians and parents. However, what must be done is still a complex decision for them as risks of deaths and disabilities have also increased.
This ethical issue has been the factor of conflict between parents and doctors and in a number of cases; guidance was required through courts (Laurance 42). The research suggests that neonates must not be given medical aid and be allowed to breathe their last “when the struggle to save them results in “intolerable” suffering that outweighs the baby’s interest in continuing to live” (Laurance 42). As far as my opinion is concerned, I believe that it is the obligation of a doctor to preserve the life of a human being wherever and whenever possible.
As far as neonates are concerned, these babies always have a chance to survive in the future and there have been cases when extremely premature babies were enabled to live a full life. One of the most encouraging aspects in this regard is that in the last decade, the rate of survival of exceedingly weak babies has more or less doubled. I strongly believe that the physicians and parents/guardians must not attempt to do anything that may put a stop to the continued existence of a little one simply for the reason that he/she won’t be a healthy and contributing adult in the future due to his unhealthy severe physical condition (Laurance 42).
However, it is unfortunate that all the answers of the mentioned dilemmas are rather difficult as there is always a clash between values conflict and principles of morality. In addition to this, it is also not easy to agree upon a consistent situation where beneficence can be chosen over autonomy and vice versa. A majority of people hold on to both the sides of the conflict i. e. “the respect for persons principle and to the principle of beneficence” that helps them to decide about the particular actions that may result in the best consequences for the patient and the family.
Unfortunately, there is no special recipe that may facilitate the involved people to decide about what is the best thing to do in situations when there is a conflict between these principles. This is also not fair to stick to one decision and disregard the other options. Thus, the best thing that can be done by a decision maker in the occurrence of such conflicts is to do a deep analysis of the situation in the most cautious manner and try to identify the values at risk and all people who may be affected by the outcomes of the decision.
For sure, the patient’s interests must be the top priority before the interests of others involved (Macklin). To cut a long story short, it is better not to utilize the neonatal intensive care “when the death of the baby can only be postponed temporarily, at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and the family” (Orzalesi). This is because in some unique circumstances, the best alternative for the betterment of the child is to withhold or withdraw intensive treatment.
Courtney from Study Moose
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