Structured ethical decision-making in a NICU

A study from the Netherlands describes how a NICU implemented a structured approach to multidisciplinary discussions and decisions for difficult ethical decisions. Meetings were chaired by an ethicist and a special online form was used to guide the discussions and summarize the content of the meeting. This approach ensured that all professionals (including nurses, social workers, pastors) directly involved with the patient were involved in the process, and used five-steps:

  1. Exploration (where all group members provide their perspectives)
  2. Agreement on the ethical dilemma/investigation of solutions
  3. Analysis (of potential solutions and their impact)
  4. Decision-making (including weighing of pros and cons)
  5. Planning actions (to ensure that decisions are implemented).

Staff perceptions before and after this process was implemented showed significant improvement in multiple domains.

Implementing structured multiprofessional medical ethical decision-making in a neonatal intensive care unit. de Boer et al 2012.