NRP Ethical Considerations 3 — Questions and Answers
Question 1: A neonate is born with a confirmed diagnosis of Trisomy 18. The parents request comfort care only. Which ethical principle most supports honoring this request?
- Justice
- Beneficence
- Autonomy (Correct answer)
- Veracity
Correct answer: Autonomy
Honoring the parents' informed decision for comfort care in a condition with very poor prognosis supports the principle of autonomy.
Question 2: In the context of NRP ethics, 'futility' generally refers to interventions that:
- Are too expensive to justify
- Cannot achieve the intended physiological goal or desired outcome (Correct answer)
- Have not been tested in clinical trials
- Are unavailable at the delivery facility
Correct answer: Cannot achieve the intended physiological goal or desired outcome
Medical futility applies when an intervention cannot achieve its intended goal, making continued attempts ethically unjustifiable.
Question 3: Which gestational age range is commonly referred to as the 'gray zone' or threshold of viability in neonatal resuscitation ethics?
- 18–20 weeks
- 22–25 weeks (Correct answer)
- 26–28 weeks
- 28–30 weeks
Correct answer: 22–25 weeks
The 22–25 week gestational age range is considered the threshold of viability where survival outcomes are highly uncertain and individualized decisions are essential.
Question 4: When a mother arrives in active labor at 24 weeks with no prior prenatal care or counseling, the best approach is:
- Withhold resuscitation due to lack of prenatal documentation
- Provide immediate comfort care only
- Initiate resuscitation and reassess based on the infant's response (Correct answer)
- Wait for ethics committee approval before acting
Correct answer: Initiate resuscitation and reassess based on the infant's response
In the absence of prior counseling, initiating resuscitation and reassessing is the recommended approach to preserve options while gathering more information.
Question 5: What role does 'prognostic uncertainty' play in ethical decision-making for threshold-of-viability neonates?
- It eliminates the need for parental input
- It supports individualized, family-centered decision-making rather than rigid protocols (Correct answer)
- It requires mandatory resuscitation in all cases
- It has no bearing on ethical decisions
Correct answer: It supports individualized, family-centered decision-making rather than rigid protocols
Prognostic uncertainty at the threshold of viability reinforces the need for individualized, family-centered ethical decision-making rather than blanket policies.
Question 6: A family from a cultural background where any withdrawal of care is unacceptable requests continued resuscitation despite a clearly hopeless prognosis. The most ethical response is:
- Immediately cease resuscitation regardless of their wishes
- Engage cultural liaisons and ethics support to find a respectful resolution (Correct answer)
- Defer entirely to the family's request without further discussion
- Transfer care to another hospital without discussion
Correct answer: Engage cultural liaisons and ethics support to find a respectful resolution
Engaging cultural liaisons and ethics support allows for respectful dialogue that honors cultural values while addressing clinical realities.
Question 7: Which statement best reflects NRP guidance on resuscitation of neonates with lethal anomalies?
- Full resuscitation must always be attempted regardless of diagnosis
- Resuscitation is generally not indicated for conditions universally fatal in the neonatal period (Correct answer)
- Parents have no role in decisions about lethal anomalies
- All anomalies should be treated equally regardless of prognosis
Correct answer: Resuscitation is generally not indicated for conditions universally fatal in the neonatal period
NRP guidance states that resuscitation is generally not indicated for conditions that are universally fatal in the neonatal period, such as confirmed anencephaly.
NRP Ethical Considerations 3
A neonate is born with a confirmed diagnosis of Trisomy 18.
The parents request comfort care only.
Which ethical principle most supports honoring this request?