Speer

Editor's Corner

Challenges of ethical decisions in neonatology

by Michael Speer, M.D.
Professor of Pediatrics—Neonatology

The role of ethics in the field of neonatology is much older than the subspecialty itself. Ethical thought encompasses both the determination of societal justice, as well as the concept of doing good, on the scales of both the individual and society as a whole.

In the day-to-day NICU environment, most ethical decisions are individual in nature and, as Doctors Garcia-Prats and McCullough note in their articles, are surrogate decisions—made by parents on behalf of their infant. The most difficult decisions are those that involve life and death, and they typically occur at the end of life. One always should remember that fiduciary refers to an individual who holds a relationship of trust or confidence—a relationship that is multi-layered and that operates in several environments simultaneously.

Doctor Guillory points out that government’s role in ethical behavior is one of resource allocation, which impacts not only the care available but how readily that care can be accessed.

Both the individual and societal ethical constructs might well be steeped in conflict. No matter what guidelines, standards, or even laws are instituted, the conflict probably will never be easily resolved. The conflict is justified and always will challenge those charged with these difficult decisions to examine their reasoning in lieu of their fiduciary responsibilities.