NRP Ethical Considerations 2 — Questions and Answers
Question 1: A baby is born at 22 weeks gestation with no signs of life after 10 minutes of resuscitation. What is the most ethically appropriate next step?
- Continue resuscitation indefinitely
- Discontinue resuscitation and focus on comfort care (Correct answer)
- Increase medication doses
- Transfer to a higher-level NICU
Correct answer: Discontinue resuscitation and focus on comfort care
After 10 minutes of no signs of life, discontinuing resuscitation and focusing on comfort care is ethically supported by NRP guidelines.
Question 2: Which ethical principle is most directly violated when a healthcare team resuscitates a neonate against clearly documented parental wishes?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Non-maleficence
Correct answer: Autonomy
Proceeding against documented parental wishes violates autonomy, the principle that respects the decision-making rights of patients and their surrogates.
Question 3: When parents and physicians disagree about resuscitation at the threshold of viability, what is the recommended approach?
- Physician decision takes precedence in all cases
- Ethics committee consultation should be sought (Correct answer)
- Parents always have absolute final say regardless of circumstances
- Resuscitation must always be attempted
Correct answer: Ethics committee consultation should be sought
Ethics committee consultation provides a structured process to navigate disagreements between families and care teams about resuscitation decisions.
Question 4: A neonate born at 23 weeks has an antenatal consultation. The parents request full resuscitation despite a poor prognosis. What is the most appropriate response?
- Refuse because the prognosis is poor
- Honor the request and attempt resuscitation (Correct answer)
- Delay resuscitation until after delivery assessment
- Consult only the attending neonatologist
Correct answer: Honor the request and attempt resuscitation
At 23 weeks, survival is possible and parental wishes for full resuscitation should be honored as resuscitation is considered an option in this gestational range.
Question 5: What does the ethical principle of 'non-maleficence' require in neonatal resuscitation?
- Always attempting resuscitation regardless of outcome
- Avoiding interventions that cause more harm than benefit (Correct answer)
- Distributing resources equally among all neonates
- Respecting parental autonomy above all else
Correct answer: Avoiding interventions that cause more harm than benefit
Non-maleficence requires that clinicians avoid interventions whose burdens outweigh their benefits, which is central to decisions about resuscitation.
Question 6: Which of the following best describes a 'time-limited trial' in neonatal resuscitation ethics?
- Resuscitation is attempted for a fixed duration to assess response before deciding to continue or stop (Correct answer)
- Resuscitation is withheld for a set period before initiating
- Comfort care is provided for a fixed time before resuscitation
- A trial of medications is given before intubation
Correct answer: Resuscitation is attempted for a fixed duration to assess response before deciding to continue or stop
A time-limited trial involves providing resuscitation for a defined period to evaluate response and gather information before making a final decision.
Question 7: Documentation of a prenatal do-not-resuscitate (DNR) agreement should ideally occur:
- Only at the time of delivery
- During antepartum counseling before delivery (Correct answer)
- After the first resuscitation attempt
- At the request of the nursing staff only
Correct answer: During antepartum counseling before delivery
Prenatal counseling allows families and providers to discuss and document DNR agreements before the high-stress delivery environment.
NRP Ethical Considerations 2
A baby is born at 22 weeks gestation with no signs of life after 10 minutes of resuscitation.
What is the most ethically appropriate next step?