NRP Ethical Considerations 5 — Questions and Answers
Question 1: Which of the following conditions is explicitly listed by NRP as one where resuscitation is NOT indicated due to near-certain early death?
- Trisomy 21 with cardiac defect
- Confirmed anencephaly (Correct answer)
- Severe intrauterine growth restriction
- Transient tachypnea of the newborn
Correct answer: Confirmed anencephaly
Confirmed anencephaly is explicitly identified by NRP as a condition where resuscitation is generally not indicated due to near-certain early death.
Question 2: During a delivery room resuscitation, a religious leader asks the team to stop resuscitation because it violates family faith traditions. The most appropriate response is:
- Stop resuscitation immediately out of respect
- Continue resuscitation and consult with the legal guardian (parent) to confirm wishes (Correct answer)
- Ask the religious leader to leave the delivery room
- Refer the decision to the hospital chaplain exclusively
Correct answer: Continue resuscitation and consult with the legal guardian (parent) to confirm wishes
Medical decisions during active resuscitation must be confirmed with the legal guardian (parent), not third parties, while respecting the family's values through ongoing communication.
Question 3: What is the primary purpose of an antenatal counseling session prior to a threatened extremely preterm delivery?
- To obtain informed consent for specific medications only
- To prepare families and establish shared goals of care before delivery (Correct answer)
- To assign a primary care physician to the neonate
- To complete mandatory hospital paperwork
Correct answer: To prepare families and establish shared goals of care before delivery
Antenatal counseling prepares families emotionally and informationally, and allows collaborative goal-setting before the high-stakes delivery environment.
Question 4: A neonatologist withholds prognostic information from parents because they believe it will cause unnecessary distress. Which ethical principle does this violate?
- Justice
- Beneficence
- Veracity (Correct answer)
- Non-maleficence
Correct answer: Veracity
Withholding relevant prognostic information violates veracity (truthfulness), which requires honest and complete disclosure to support informed decision-making.
Question 5: After a failed resuscitation, parents ask the team if they made the right decision to attempt resuscitation. The most ethically appropriate response is:
- Confirm the decision was correct without further discussion
- Provide honest, compassionate debriefing acknowledging uncertainty and supporting the family (Correct answer)
- Avoid the question to prevent additional emotional distress
- Refer all post-resuscitation conversations to hospital legal counsel
Correct answer: Provide honest, compassionate debriefing acknowledging uncertainty and supporting the family
Honest, compassionate debriefing after a failed resuscitation respects the family's need for truth and emotional support while acknowledging clinical uncertainty.
Question 6: Which of the following best illustrates an ethical conflict between beneficence and autonomy in neonatal resuscitation?
- A team performs CPR on a full-term neonate in cardiac arrest
- A team resuscitates a neonate against the family's informed refusal of care (Correct answer)
- A team provides oxygen to a premature neonate
- A team consults an ethics committee on a complex case
Correct answer: A team resuscitates a neonate against the family's informed refusal of care
Resuscitating against an informed parental refusal illustrates the tension between acting in the infant's perceived best interest (beneficence) and respecting parental decision-making rights (autonomy).
Question 7: When an extremely premature neonate survives resuscitation with severe neurological injury, and parents request withdrawal of life support, the care team should:
- Refuse withdrawal because the neonate survived resuscitation
- Engage in shared decision-making, provide honest prognosis, and support the family's decision if consistent with the infant's best interests (Correct answer)
- Immediately withdraw all support without further discussion
- Escalate care intensity to prevent withdrawal of support
Correct answer: Engage in shared decision-making, provide honest prognosis, and support the family's decision if consistent with the infant's best interests
Shared decision-making, honest prognostic disclosure, and support for family decisions consistent with the infant's best interests are the ethical foundations for withdrawal of life support conversations.
NRP Ethical Considerations 5
Which of the following conditions is explicitly listed by NRP as one where resuscitation is NOT indicated due to near-certain early death?