Page 10 - American Nurse Today January 2008

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family-friendly care. Focusing on the quality of life as determined by a culturally sensitive, negotiated, family-centered approach signifi- cantly improves the quality of life for the tiny patient and his family. As nurses help transform the par- ent’s grief and pain into comfort and mutual support, they too find satisfaction.
Though most hopelessly ill
neonates die fairly soon after the
withdrawal of life-sustaining meas-
ures, some survive for D
an extended period. In
these cases, having
hospice personnel pro-
vide palliative care in
the home may be the
best alternative. If so,
a neonatal nurse edu-
cator may need to
teach hospice person-
nel, who are expert at caring for treatment and killing by dehydra- dying adults, about caring for dying tion. When death is inevitable, pro- infants. Babies present special viding gentle palliative care is the needs, including normal newborn ethical alternative. Medical treat- care, skilled pain management, care ment may be futile: Nursing care
of the skin and mucous mem- never is! ✯ branes, and care for dyspnea, nau-
for the time being.
As for your role, you should help
facilitate a careful, modest, open sharing of information that allows parents to make decisions. If they have concerns, a review by an ethics committee should alleviate them.
Nurses who participate in pallia- tive care for a dying infant give an inestimable gift to baby and parents alike. The choice parents and clini- cians face doesn’t have to be be- tween torturing with ineffective
oes a newborn have the moral worth
of an adult?
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sea, and seizures. Selected references
Carter BB. Comfort care principles for the
Final thoughts
high-risk newborn. NeoReviews. 2004;5(11):493.
Institute of Medicine of the National Acade- mies. When Children Die: Improving Pallia- tive and End-of-Life Care for Children and Their Families. Washington, DC: Institute of
Most questions raised by these situ-
ations can’t be answered in one ar-
ticle, if they can be answered at all.
Does a newborn have the moral
worth of an adult? Indeed, what is
it that gives a person worth? Is it
intrinsic? Does one have to earn it? Medicine; 2003.
Philosophers may quibble about Pellegrino E. Decisions at the end of life: the
Fletcher J. Indicators of humanhood: a tenta- tive profile of man. Hastings Cent Rep. v.2 #5, November 1972.
10 American Nurse Today
Volume 3 , Issue 1
whether or not infants achieve “hu- manhood,” but who could argue that an infant isn’t a human being with human rights? No matter how small and underdeveloped, a new- born deserves kindness and physi- cal care, and the newborn’s family deserves emotional support.
If the research can be believed, the revised Baby Doe Regulations aren’t overly burdensome and do prevent the abuses represented by the Baby Doe cases. Therefore, the law should remain as written
use and abuse of the concept of futility. Life and Learning X: The Proceedings of the Tenth University Faculty for Life Conference June 2000 at Georgetown University. Washington, DC: Georgetown University Press; 2000:91.
Pless JE. The story of Baby Doe. N Engl J Med.1983:309:664.
For a complete list of selected references, vis- it www.AmericanNurseToday.com.
Leah Curtin, DSc(h), RN, FAAN, is a Clinical Professor of Nursing at the University of Cincinnati College
of Nursing in Ohio, and was the Editor-in-Chief of Nurs- ing Management for 20 years. She also is Managing Partner of Metier Consultants, and the Director of Cross Country Education’s Nurse Manager Boot Camp.