An interesting study ( CL Cummings et al. J Pediatr 2018; 199: 57-64) examined performance levels on a reliable ethics knowledge questionnaire (TEK-Neo). They found that out of 36 questions:
- Medical students answered 25.9 correctly
- Neonatal nurses/practitioners answered 27.7 correctly
- Neonatal attendings answered 28.8 correctly
- Neonatal fellows answered 29.8 correctly
- Clinical ethicists answered 33.0 correctly
While the overall take-home from this study is that the TEK-Neo provides a reliable gauge of neonatal ethic knowledge, I was more interested in some of the specific questions. Here are three true-or-false questions:
- #20. “Medically provided fluids and nutrition constitute a medical intervention that may be withheld or withdrawn for the same reasons that justify the medical withholding of other medical treatments.”
- #21. “Parents of a critically ill 3-day old infant in the NICU born at 26 weeks on noninvasive positive pressure ventilation decline reintubation in the setting of respiratory failure and new grade 3 IVH B/L. Their informed decision to refuse further life-sustaining medical treatment ought to be respected.”
- #24. “A 14 day-old full-term boy has sustained severe anoxia perinatally and has severe hypoxic-ischemic encephalopathy confirmed on continuous electroencephalogram by persistently low -voltage isoelectric activity. He is unresponsive to his environment. In this situation, the patient’s enteral nutrition (administered via oral gavage tube) may be ethically withdrawn.”
Though the correct answer to these three questions is true, my experience is that parents rarely are interested in withholding or withdrawing care in these type of scenarios.
