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Proxy consent in neonatal care--goal-directed or procedure-specific?
1Wirral Hospital, Arrowe Park, Wirral, Merseyside CH49 5PE. donal.manning@whnt.nhs.uk
Insights
Obtaining informed consent for neonatal care interventions is complex due to parental preferences and practical constraints. Considering consent for a package of care, rather than individual interventions, may be a more ethical approach.
Area of Science:
- Neonatal medicine
- Bioethics
- Medical law
Background:
- Current guidelines for consent in neonatal care are problematic and inconsistently applied.
- Postnatal limitations on information sharing and decision-making complicate neonatal consent processes.
- Significant individual and cultural variations exist in parental desire for involvement in infant decision-making.
Purpose of the Study:
- To explore the challenges in establishing appropriate practice guidelines for consent in neonatal care.
- To examine the ethical considerations surrounding parental consent for neonatal interventions.
- To evaluate alternative approaches to consent in neonatal settings.
Main Methods:
- Review of existing literature on neonatal consent and decision-making.
- Analysis of empirical research on parental preferences and cultural variations.
- Ethical analysis of consent models in neonatal intensive care.
Main Results:
- Wide variation in current consent practices for neonatal interventions.
- Potential conflicts between parental wishes and infant best interests can necessitate overriding consent.
- Parental involvement in decision-making varies significantly based on individual and cultural factors.
Conclusions:
- Universal consent for all individual neonatal interventions presents substantial difficulties.
- Consent for a comprehensive care package (e.g., special, intensive, palliative care) may be more ethically sound than individual intervention consent.
- Revising consent strategies is crucial for ethical neonatal care.
Abstract:
The prescription of practice guidelines for consent in neonatal care that are appropriate for all interventions faces substantial problems. Current practice varies widely. Consent in neonatal care is compromised by postnatal constraints on information sharing and decision-making. Empirical research shows marked individual and cultural variation in the degree to which parents want to contribute to decision-making on behalf of their infants. Conflict between the parents' wishes and the infant's best interests could arise if consent for a recommended intervention were refused, and parental refusal of consent may have to be overridden. Consent to an appropriate package of care (such as special, intensive or palliative care) may be morally preferable to a universal requirement to seek consent for all individual interventions entailed by that package.
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