Anemia of Prematurity - Portal Neonatal

influences of external considerations. In the NICU, as elsewhere, goods that are pursued include
health, prevention or elimination of disease or morbidity (including iatrogenic sequelae of treatment),
relief of unnecessary pain or suffering, and the prolongation of life.
Joy Penticuff, a nurse writing in the text Ethics and Perinatology, states that the goods desired for
infant patients in the NICU include comfort, opportunities for affectionate parental interaction that
promotes infant-parent emotional bonding, and protection and nurturance of the infant's future
emotional, cognitive, and physical development. While these and others are desired goods for
neonatal patients, they may not be easy to accomplish. At times, barriers to the accomplishment of
these desired goods seemingly are present.
Consider the following barriers to achieving the good:
• Lack of knowledge: Healthcare professionals may need larger amounts and more diverse
types of information.
• Lack of sufficient time: Healthcare professionals may need to act immediately and may not
have the luxury of contemplation.
• Lack of interest: Some members of the healthcare team, perhaps someone known well, may
not be interested in achieving the good.
• Emotional barriers: These may be present in the individual healthcare provider, colleagues,
parents, and others.
• Past experiences: Experiences in similar cases or with similarly charged emotions may exist.
• Intimidation: Healthcare providers with real or perceived power may intimidate others.
• Lack of perceived power or a poor team concept: Lack of being valued as a contributor to the
treatment team can provide a barrier.
• Lack of policies or guidelines: Policies or guidelines may not exist to facilitate action or an
organized approach to a problem.
• Lack of a concept of goals for this patient
• Lack of resources: Monetary, equipment, personnel, or other lack of resources can provide
barriers to achieving the good.
CONCLUSION Section 7 of 8
Perhaps the final consideration in answering these questions is that each day, healthcare
professionals must work within the realities of the cases before them. Each patient has a unique set of
problems that prompt action, moral reflection, and re-evaluation. Each family brings with it the
awareness that the prevailing (or traditional) concept of family must be adjusted to what comprises the
group of nurturing interested persons for this baby. Each diagnosis challenges the collective
knowledge and notion of effective care of a healthcare team. Each healthcare dilemma reminds
caregivers of their limitations, including uncertainty, the human predicament, lack of knowledge, and
decision-making abilities. All of these are tempered by the moral constraints under which they act.
Healthcare professionals must, at times, accept the reality that tragic cases have tragic outcomes; the
healthcare professional may not always rest easy with decisions wherein the pursuit of some good
yields only emptiness. As John Dewey stated, "All the serious perplexities of life come back to the
genuine difficulty of forming a judgment as to the values of a situation; they come back to a conflict of
goods." In summary, the reader and practitioner are asked to not only inquire "What good are we
doing here?" but also to move toward defining goals, perhaps for the specialty, but more realistically,
for the individual patient. Base each patient's care on goals of care that are consonant with
professional goals, societal norms, institutional mission, and mutually derived goals with parents or
families. This requires time and thoughtful reflection while communicating with families and advocating
for the patient's benefit. Consider the potential value of guidelines in the process of working through
common or recurring problems, ethical or otherwise, in the nursery and hospital. In so doing, the good
that individual healthcare professionals perform may become more evident to themselves, their
colleagues, and their patients.