NEONATAL ETHICS

SAUNAR, DANICA
SOLIMAN, KATHLEEN
Ethical issues in the treatment of ELBW neonates

➤ Neonate: a neonate is also called a newborn. The neonatal

period is the first 4 weeks of a child's life.
➤ Extremely low birth weight (ELBW) infant: defined as
one with a birth weight of less than 1000 g. Most extremely
low birth weight infants are also the youngest of premature
newborns, usually born at 27 weeks' gestational age or
younger.
Concerns about the issue
➤ The
primary cause of low birthweight is premature birth. Being born early
means a baby has less time in the mother's uterus to grow and gain weight.
➤ ELBW infants comes with various congenital birth defects that makes
them vulnerable to complications and risk of mortality;
Infection
Breathing problems
Neurologic problems
Sudden infant death syndrome (SIDS)
Treatment

➤Nearly all low birthweight babies

need specialized care in the
Neonatal Intensive Care Unit
(NICU) until they gain weight
and are well enough to go home.
Ethical Dilemma
➤The basic ethical issue is who should be the one to
decide whether an ELBW neonate should be
resuscitated after birth and if it survives whether it
will be treated according to all protocols of good
clinical practice, or it will be given only palliative
care.
➤Most physicians think that it is them rather than the
parents who should make the main decisions. On the
other hand, parents think they should be the ones with
the main role in decision making.
➤The biggest moral issue during the decision-making
about further treatment is its influence on the family of
the child who might have severe neurological
consequences.
Social Concerns about the issue
➤Modern technology increases the chances of survival
even of extremely low birth weight (ELBW) newborns,
with a minimum number of complications.
➤I n countries with guides and expert group
recommendations, neonatologists’ decisions on limiting
or withdrawing life-sustaining medical treatment (LSMT)
in critically ill patients are led by these recommendations.
➤However, what should be done in a country (ex.
Philippines) where such recommendations are not
available?.
➤The only suggestion made by an informal group
of neonatologists is to resuscitate neonates born
after 23 gestational weeks (GW) and those
weighting more than 400 g at birth.
Ethical Resolutions
➤Physicians have a duty to inform the newborn’s parents
about resuscitation procedures and the potential outcome
and to ask for consent for treatment and other
procedures.
➤The moral obligation of the physician is to act in the best
interest of the patient (Beneficence). When it is difficult
to make a decision, parents’ wishes must be considered.
➤In order to overcome these dilemmas, the
parents and physicians should be equally
involved in decision making process about
limiting or withdrawing LSMT.
➤Every parent should be informed in detail about
the ELBW newborns’ treatment results.
References
➤ Doronjski,A., & Stojanović, V. (2016). Ethical issues in
the treatment of extremely low birth weight neonates.
Croatian Medical Journal, 57(4), 395–397. doi: 10.3325/
cmj.2016.57.395
➤ Neonate: MedlinePlus Medical Encyclopedia. (n.d.).
Retrieved February 8, 2020, from https://medlineplus.gov/
ency/article/002271.htm
Care for the Elderly/
Aged
TICOT, RAILIE KATE R.
Ethical issues in Care for the Elderly/Aged

➤Elderly: a chronological age of 65 years old or older.

People aged from 65 through 74 years old are referred
to as “early elderly” and those over 75 years old as
“late elderly”.
➤Aged: aging results from the impact of the
accumulation of a wide variety of molecular and
cellular damage over time.
Concerns about the issue
➤Meeting the needs of the old
The importance of taking time with the old
person in order to find out what would be best
for individual needs, while at the same time
using their professional knowledge to provide
the most suitable care for the person.
Concerns about the issue
➤Meeting the needs of the old
Stressful work situation at mealtimes or
bedtime, when there are many old persons
needing attention and help at the same time,
with a limited number of staff is limited
available.
Concerns about the issue

➤Pliability towards the old

Pliability towards the old implied respecting
them as individuals with different personalities
and as aging persons with diminished strengths
and pace.
Concerns about the issue
➤Difficulties in meeting aggressiveness of the old
An old person can suddenly show another side due
to side effects of drugs, symptoms of abstinence or
a stage of delirium. For the carers this means that
their ethical moral self is challenged by their own
safety but by also the risk of harming to the old
person when coercive measures have to be taken.
Concerns about the issue
➤Co-workers who are offensive to the old
The relationship with co-workers is challenged
when carers find that their co-workers offend
the old persons. This is frustrating for the
carers and trying to defend the old persons
could mean a rebuke from their co-workers.
Concerns about the issue
➤Supportive and non-supportive leaders
It was particularly hard when their own moral
thinking did not coincide with how they
perceived the organization, or if their
managers, leaders and co-workers did not act
in an ethical moral way.
Treatment
➤New medical treatments and
technologies are increasing the
number of people seeking long-term
care. It is challenging to provide
long-term advanced treatment and
care to the population considering
the increase in older population.
Treatment
➤The ethical value of patient autonomy and surrogate
autonomy should be respected but weighed against the
use of expensive treatment in futile case circumstances
with current increase in healthcare costs. Hence, in case
of futile treatments, families and patients can ethically
consider the option for comfort care.
Ethical Dilemma
➤When an old person is moved to a different assisted living
facility or back to the private home, and the carer is no longer
responsible for the care, it can be difficult to break off the
existing relation.
➤The old person demands that the carer come for a visit,
drawing a fine line between what the carer can do in private
when the professional responsibility is completed. An ethical
moral dilemma occurs for the carer.
Ethical Dilemma
➤Close relatives and care giver fight for the rights and welfare
of the old. Despite the carers intellectually understanding the
reactions of close relatives, it is trying and turns particularly
difficult if the close relatives are threatening the carers.
➤To carry an autonomous morale implies making a personal
decision and having a sincere choice. This means that the
carers had relied on their personal moral thinking when caring
for the old in different situations.
Ethical Dilemma

➤Another dilemma in carers is when they need to

decide if they should treat the old based on how
they like or based on what their co-workers and
managers told them.
Social Concerns about the issue
➤Radical development in health care organizations where the
fiscal aspects, such as keeping to the budget and cutting costs,
do not imply that the number of staff and beds is reduced
without taking into consideration the needs of the population.
➤Consistent with global trends, we have an increase in the
older population and increasing levels of both morbidity and
multi-morbidity.
Ethical Resolutions

➤An ethically aware caregiver strives to invite the

patient into a caring relation that mediates strength as
well as respect for the integrity and wholeness of the
human being. An ethically aware caregiver also strives
to “do well,” “do right,” and “take responsibility,” and
he/she wanted to show the patient respect.
➤Acting ethically in the moment when goodness
becomes a conscious choice for the caregiver. To
act ethically in the daily work requires a
professional freedom, enabling caregiver to
choose and decide just in the moment when
caregiver and patient meet each other.
➤The central aspect of the care of older people is
respect for the individual’s right to decide for
themselves. This is what the carers tried to do
meeting the individual's needs and wishes.
➤In doing so, the carers were attentive to the
needs and wishes of the old persons, they took
responsibility for caring for them and meeting
their needs, they used their competence and they
received a response from the old persons on the
care provided.
References
➤ Caring
and Social Sciences. (n.d)n Retrieved february12,
2020, from http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3349146/#__ffn_sectitle
➤ Fagerberg, I. & Engstorm, G. (2012). Care for the old – A
matter of ethics, organization and relationships. Int J Qual
Stud Health Being, 2012; 7:10. Doi:10.302/qhw.v7io.
9684.
 Ethical issues:
Surrounding End of Life
SUALAN, IVAN N.
 Ethical issues: Surrounding End of Life

➤End of Life: relate to someone's death and the time

just before it, when it is known that they are likely
to die soon from an illness or condition.
Concerns about the issue

➤Families playing the crucial role of surrogate or

proxy are emotionally attached to the in capacitated
patient and hence their moral interest (emotional,
financial pressure, etc.) may be diverse in opting for
a treatment or declining them.
Concerns about the issue
➤The issue of medical futility is a clinical situation in medical
ethics that may pose challenges in providing care at the end
of life.
➤Reference to an intervention as being medically futile is a
common description; however, clear definitions of medical
futility are still lacking and few clinical scenarios exist in
which there may be uniform agreement that a specific
intervention is medically futile.
Concerns about the issue
➤The withdrawing and withholding of life-sustaining
treatment in the management of patients at the end of
life may be appropriate both medically and ethically.
➤First, certain interventions may simply be medically
futile, in which case there are no ethical, legal, or
medical requirements to administer care that offers
no benefit.
Concerns about the issue
➤Most physicians involved in end-of-life care have
received requests for physician-assisted suicide.
Physician-assisted suicide involves the physician’s
providing the means to end the patient’s life,
usually by prescribing a lethal dose of a sedative -
hypnotic medication that the patient self-
administers.
Treatment
➤Dying patients may choose hospice care. A
holistic and philosophical approach to end of life
care, hospice brings doctors, nurses, social
workers and other professionals together as a
care team.
➤The hospice team’s goal is to make the patient as
comfortable as possible during his or her final
days. Hospice emphasizes pain control, symptom
management, natural death, and quality of life to
comfort the patient’s physical body.
Treatment
➤Palliative care works to achieve one of the primary goals
of healthcare: relief of symptoms. Palliative care is an
option for patients who are seriously or terminally ill. It
focuses on achieving the best possible quality of life for a
patient by emphasizing total and comprehensive care for
all a patient’s needs
Treatment
➤Palliative care is similar to that of hospice care.
However, palliative care is not restricted to patients near
the end of life and can be used in both acute and long
term care settings. One striking similarity between
hospice and palliative care is the use of an
interdisciplinary team of professionals including doctors,
nurses, social workers, etc.
Ethical Dilemma
➤When an old person is moved to a different assisted living
facility or back to the private home, and the carer is no longer
responsible for the care, it can be difficult to break off the
existing relation.
➤The old person demands that the carer come for a visit,
drawing a fine line between what the carer can do in private
when the professional responsibility is completed. An ethical
moral dilemma occurs for the carer.
Ethical Dilemma
➤Communication breakdowns, patient autonomy
being compromised, ineffective symptom
management, non-beneficial care, and shared
decision making.
➤One of the dilemmas that can occur relates to the
cessation of medical interventions in patients.
Ethical Dilemma
➤If a patient has an order for a DNR or DNAR, it
means that the patient has elected for cardiopulmonary
resuscitation (CPR) to not be initiated or administered
in the event of a cardiac arrest.
➤Electing to have or not to have CPR is a difficult but
common medical decision that patients nearing the
end of life often make.
Social Concerns about the issue

➤Societal consequences of inordinate end-of-life

expenditures abound
➤Patients who require palliative and/or hospice care can
experience extreme challenges, including depression,
anger, and anxiety; intense physical pain or discomfort;
financial strain; social isolation; and family conflict.
Ethical Resolutions
➤Promotes and encourages research and education in the
areas of palliative care and end-of-life issues within
psychology training at all levels.
➤Encourages psychological research and the use of
clinical skills to assess and address the psychological
factors that have an impact on end-of-life decision
making and will to live.
➤Promotes psychologists' collaboration with other
disciplines and organizations in the formulation
and implementation of a behavioral and
psychological research agenda on palliative care
and end-of-life issues.
➤Encourage psychologists to obtain training in
ethics in the context of diversity, as applied to
palliative and end-of-life decisions and care.
➤Encourage psychologists to inform themselves
about criminal and civil laws that have bearing
on assisted dying in the states in which they
practice.
➤Encourage psychologists to recognize the
powerful influence they may have with
individuals who are considering assisted dying.
References

➤ Kanekar, S. K. (2016, May). Ethical Issues Surrounding

End-of-Life Care: A Narrative Review. Retrieved from
Healthcare MPDI: https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC4934577/