Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • State of the Art
  • Published:

State-of-the-Art

The role of a pediatric ethics committee in the newborn intensive care unit

Journal of Perinatology volume 31, pages 1–9 (2011)Cite this article

Subjects

Abstract

Institutional Ethics Committees are commonly available in hospitals with newborn intensive care units, and may serve as a valuable resource for staff and parents dealing with difficult ethical decisions. Many clinicians may be unaware of when the committee might be helpful, or how it functions. After a brief historical introduction, two cases are presented as illustrations of pediatric ethics committee function. The first involves consideration of cardiac surgery for an infant with ventricular septal defect and Trisomy 13. The second involves disagreement between staff and parents regarding possible provision of cardio-pulmonary resuscitation in a terminally ill newborn. Principles and considerations often brought to bear in committee deliberations are reviewed for each case. Neonatologists, staff and families should be aware of this potentially valuable resource, and are encouraged to use it for situations of moral distress, conflict resolution or ethical uncertainty.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Duff RS, Campbell AGM . Moral and ethical dilemmas in the special-care nursery. New Engl J Med 1973; 289: 890–894.

    Article  CAS  Google Scholar 

  2. Pence G . Classic Cases in Medical Ethics, 4th edn. McGraw-Hill: New York, 2004, pp 217–218.

    Google Scholar 

  3. Shaw A, Randolph JG, Manard B . Ethical issues in pediatric surgery: a national survey of pediatricians and pediatric surgeons. Pediatrics 1977; 60 (4-Part 2): 588–599.

    CAS  PubMed  Google Scholar 

  4. In the Matter of the Treatment and Care of Infant Doe. Circuit Court of the County of Monroe, State of Indiana 1982 Cause No. GU 8204-004A. In re Infant Doe, No. GU8204A (Monroe County Cir., Ind. April 12, 1982.

  5. Pence G . Classic Cases in Medical Ethics, 4th edn. McGraw-Hill: New York, 2004. pp 219–223.

    Google Scholar 

  6. President's Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research. Deciding to Forgo Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions 1983; 160–170. (Accessed on 10/23/08 at http://www.bioethics.gov/commissions/).

  7. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals: Update 1. Oakbrook: Terrace IL, 1999. pp R1–R11.

  8. American Academy of Pediatrics Committee on Bioethics. Institutional Ethics Committees. Pediatrics 2001; 107: 205–209.

    Article  Google Scholar 

  9. American Medical Association Council on Ethical and Judicial Affairs. Code of Medical Ethics. American Medical Association: Chicago, 2006.

  10. Perkins HS, Saathoff BS . Impact of medical ethics consultations on physicians: an exploratory study. Am J Med 1988; 85: 761–765.

    Article  CAS  Google Scholar 

  11. Schneiderman LJ, Gilmer T, Teetzel HD . Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med 2000; 28: 3920–3924.

    Article  CAS  Google Scholar 

  12. Schneidermann LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting. JAMA 2003; 290: 1166–1172.

    Article  Google Scholar 

  13. Forde R, Pedersen R, Akre V . Clinicians’ evaluations of clinical ethics consultations in Norway: a qualitative study. Med Health Care and Philos 2008; 11: 17–25.

    Article  Google Scholar 

  14. Mercurio MR . Pediatric Ethics Committees. In Miller G (ed). Pediatric Bioethics. Cambridge University Press: New York, 2010, pp 87–110.

    Google Scholar 

  15. Hester DM . (ed). Ethics by Committee. Rowman & Littlefield: New York, 2008.

    Google Scholar 

  16. Lyren A, Ford PJ . Special considerations for clinical ethics consultation in pediatrics: pediatric care provider as advocate. Clin Pediatr 2007; 46: 771–776.

    Article  Google Scholar 

  17. Mercurio MR . Introduction: taking the time for medical ethics. Semin Perinatol 2009; 33: 353.

    Article  Google Scholar 

  18. Mercurio MR . Physicians’ refusal to resuscitate at borderline gestational age. J Perinatol 2005; 25: 685–689.

    Article  Google Scholar 

  19. Graham EM, Bradley SM, Shirali GS, Hills CB, Atz AM . Effectiveness of cardiac surgery in Trisomies 13 and 18 (from the Pediatric Cardiac Care Consortium). Am J Cardiol 2004; 93: 801–803.

    Article  Google Scholar 

  20. Kaneko Y, Kobayashi J, Yamamoto Y, Yoda H, Kanetaka Y, Nakajima Y et al. Intensive cardiac management in patients with Trisomy 13 or Trisomy 18. Am J Genet part A 2008; 146A: 1372–1380.

    Article  Google Scholar 

  21. American Academy of Pediatrics Committee on Bioethics. Guidelines on forgoing life-sustaining medical treatment. Pediatrics 1994; 93: 532–536.

    Google Scholar 

  22. Diekema DS . Parental refusals of medical treatment: The harm principle as threshold for state intervention. Theor Med 2004; 25: 243–264.

    Google Scholar 

  23. Oxford English Dictionary. (Accessed on 1/23/10 at http://www.askoxford.com/concise_oed/futile?view=uk).

  24. Helft PR, Siegler M, Lantos J . The rise and fall of the futility movement. N Engl J Med 2000; 343: 293–296.

    Article  CAS  Google Scholar 

  25. Kamm FM . Morality, Mortality Vol II: rights, duties, and status. Oxford University Press: New York, 1996, pp 150–151.

    Google Scholar 

  26. Mercurio MR . The Conscientious Practice Policy: a futility policy for acute care hospitals. Conn Med 2005; 69: 417–419.

    PubMed  Google Scholar 

  27. Council on Ethical and Judicial Affairs. American medical association: medical futility in end-of-life care: report of the council on ethical and judicial affairs. JAMA 1999; 281: 937–941.

    Article  Google Scholar 

Download references

Acknowledgements

I thank Dr Vineet Bhandari for suggesting the article and for helpful advice regarding format and content, and Dr Doug Diekema for helpful discussion.

Author information

Authors and Affiliations

  1. Department of Pediatric, Yale Pediatric Ethics Program, Yale University School of Medicine, New Haven, CT, USA

    M R Mercurio

Authors
  1. M R Mercurio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M R Mercurio.

Ethics declarations

Competing interests

The author declares no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mercurio, M. The role of a pediatric ethics committee in the newborn intensive care unit. J Perinatol 31, 1–9 (2011). https://doi.org/10.1038/jp.2010.39

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.39

Keywords

This article is cited by

Search

Advanced search

Quick links