The experience of clinical ethics consultation at the Neonatal Intensive Care Unit of the Fondazione Policlinico Universitario “A. Gemelli”, IRCSS

Abstract

Introduction: In recent decades, Clinical Ethics Consultation (CEC) has assumed an important role in clinical healthcare field, not only as a support in identifying the ethical issues involved in the patient’s clinical history, but also to facilitate the decision-making process. Neonatal Intensive Care (NICU) has proven to be a peculiar area in which the values at stake require appropriate consideration in order to guarantee the pursuit of the newborn’s good in taking charge of his/her clinical condition and of the family. Objective: Presentation of the experience of the CEC Service at Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome (Italy) within NICU. Methods: Through a retrospective investigation we analysed: 1. the number of CECs requested and processed by the CEC Service in the NICU from 2016 to today, including consultations carried out for newborns coming from the “Perinatal Hospice” programme; 2. the form in which the consultancy was developed (“standard” one or Shared Document for Healthcare Ethics Planning”); 3. the ethical questions underlying the requests. Results: The number of CECs increased progressively over time, going from 3 in 2016 to 19 in 2022. The CEC proved to be a valuable support for the neonatal team and for the parents. In fact, the data emerging from the analysis show how the CEC, through interdisciplinary evaluations, has facilitated the identification of emerging ethical issues; contributed to the communication and decision-making process in order to guide towards the ethically adequate therapeutic option; promoted palliative care and, where possible, the development of a shared care planning, with the aim, shared with the healthcare team and the family, to pursue the greatest possible good for the newborn. Finally, the “dynamic” character of the CEC has made it possible to reformulate, in some cases, the newborn’s care plan. Conclusions: In recent years, the growing number of CEC requests analyzed underlines the increasingly important role that ethical consultancy has within such a peculiar and delicate context as NICU is, where the beginning of life and the end of life often coexist, generating ethical dilemmas in the healthcare team and in the family.