NRP Ethical Considerations 4 — Questions and Answers
Question 1: A birth team learns mid-resuscitation that a 23-week neonate has bilateral absent cortex on point-of-care imaging. What is the most appropriate action?
- Continue full resuscitation without changes
- Immediately withdraw all support without parental discussion
- Pause to communicate with the family and reassess the goals of care (Correct answer)
- Increase resuscitation intensity
Correct answer: Pause to communicate with the family and reassess the goals of care
New prognostic information should prompt a reassessment of goals of care in collaboration with the family rather than unilateral action.
Question 2: How does the principle of 'justice' apply to resource allocation during neonatal resuscitation in a mass casualty or resource-limited setting?
- Oldest patients receive priority for resources
- Resources should be allocated to maximize overall benefit and fairness (Correct answer)
- Each neonate receives identical resources regardless of prognosis
- Justice has no role in acute resuscitation decisions
Correct answer: Resources should be allocated to maximize overall benefit and fairness
Justice in resource-limited settings requires allocation strategies that maximize overall benefit and treat patients fairly based on need and likely outcome.
Question 3: Parents request that resuscitation be stopped after 15 minutes with no response in a 26-week neonate. The team believes the infant may still recover. What is the most appropriate response?
- Immediately stop all resuscitation
- Discuss the clinical situation transparently and seek shared decision-making (Correct answer)
- Override parental wishes and continue indefinitely
- Contact hospital administration for authorization
Correct answer: Discuss the clinical situation transparently and seek shared decision-making
Transparent communication and shared decision-making allow the team and family to reach a collaborative decision based on all available information.
Question 4: Which of the following is an example of 'substituted judgment' in neonatal ethics?
- A physician makes the decision alone based on clinical guidelines
- Parents decide what the infant would want if capable of expressing a preference (Correct answer)
- An ethics committee imposes a decision on the family
- Nurses determine the level of care based on available staffing
Correct answer: Parents decide what the infant would want if capable of expressing a preference
Substituted judgment occurs when surrogates (typically parents) make decisions based on what the patient would want, applied in neonatology to represent the infant's best interests.
Question 5: A hospital policy mandates resuscitation of all neonates born at or after 23 weeks. A family at 23 weeks requests comfort care due to severe congenital anomalies. What is the most appropriate next step?
- Follow hospital policy and resuscitate without discussion
- Ignore hospital policy and honor the family request immediately
- Engage the ethics committee to reconcile the policy with the family's individualized circumstances (Correct answer)
- Transfer care to another hospital
Correct answer: Engage the ethics committee to reconcile the policy with the family's individualized circumstances
Ethics committee involvement helps reconcile institutional policies with the need for individualized, family-centered care in exceptional circumstances.
Question 6: Which ethical concept is described when a care team provides aggressive resuscitation to a clearly non-viable neonate primarily to avoid legal liability?
- Defensive medicine conflicting with non-maleficence (Correct answer)
- Appropriate application of beneficence
- Correct use of justice principles
- Standard application of NRP guidelines
Correct answer: Defensive medicine conflicting with non-maleficence
Providing aggressive resuscitation for legal protection rather than patient benefit is defensive medicine that conflicts with non-maleficence by potentially causing harm without benefit.
Question 7: In neonatal resuscitation ethics, what does 'best interest standard' mean?
- The standard that maximizes financial benefit for the institution
- Decision-making guided by what would most benefit the neonate's overall well-being (Correct answer)
- Following the most aggressive treatment available
- The legal standard that protects physicians from liability
Correct answer: Decision-making guided by what would most benefit the neonate's overall well-being
The best interest standard guides surrogate decisions by asking what course of action would most benefit the neonate's overall well-being, including quality of life.
NRP Ethical Considerations 4
A birth team learns mid-resuscitation that a 23-week neonate has bilateral absent cortex on point-of-care imaging.
What is the most appropriate action?