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Moral distress: an inevitable part of neonatal and paediatric intensive care?
  1. David Field1,
  2. Jenna Deeming2,
  3. Lucy K Smith1
  1. 1The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, University of Leicester, Centre for Medicine, Leicester, UK
  2. 2Neonatal Unit, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Dr Lucy K Smith, The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK; lucy.smith{at}le.ac.uk

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The paper by Prentice et al1 reports a systematic review of moral distress occurring in neonatal and paediatric intensive care units. This term, which may be unfamiliar to many readers, has been defined as the anguish experienced when a health professional makes a clear moral judgement about what action he/she should take but is unable to act accordingly due to constraints (societal, institutional or contextual).2 In a situation of moral distress, the health professional can see, from their point of view, that there is an ethically correct action but is powerless to act, a situation that will be familiar to all those who work in neonatal or paediatric intensive care teams.

Moral distress is not a new phenomenon, although the scenarios where it arises may have changed due to developments in society's beliefs and the healthcare system and dramatic improvements in technology. Perhaps the most clear UK example of how the views of society at large have changed in this context over time comes from the trial of Dr Leonard Arthur (https://en.wikipedia.org/wiki/Leonard_Arthur; accessed 21 March 2016). In 1981, Dr Arthur, a paediatrician based in the English Midlands, was tried for attempted murder following the death of a newborn baby with Down's syndrome whom he had prescribed ‘nursing care only’ and sedatives. At Dr Arthur's trial, the president of the London College of Physicians gave evidence in which he said, “I say that it is ethical, in the case of a child suffering from Down's, and with a parental wish that it should not survive, to terminate life providing other considerations are taken into account such as the status and ability of the …

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