Advances in life-sustaining medical technology as applied to
neonatal cases frequently present ethical concerns with a strong
emotional component. Neonates delivered in the “gray area”
gestation period of approximately 23–25 weeks may result in
situations where various people involved in such cases may feel
“held hostage” to technological imperatives. Legal
decisions and standards have evolved that are discordant with the
views of many clinicians most familiar with the treatment of such
patients. Increasing concerns regarding such scenarios have fueled
much academic and professional debate about the need for consensus
about ethical limits to clinical interventions with high probability
of nonbeneficial impact. While at least some clinicians and ethicists
may be inching toward consensus regarding limits to such treatment,
the voices of some bedside personnel, particularly neonatal intensive
care unit (NICU) nurses, have been relatively muted in this debate. At
least one previous survey of clinicians, which included nurses, indicated
that many nurses experienced a high level of “moral distress”
regarding aggressive courses of treatment for some patients. Some of this
distress results from a feeling of powerlessness regarding treatment
decisions, coupled with a high intensity of hands-on contact with the
patients and family. Lack of authority coupled with high responsibility
may itself be a recipe for a different kind of futility.
Impact of hands-on care on infant sleep in the neonatal intensive care unit