Understanding, avoiding, and resolving end-of-life conflicts in the NICU

Parents and health care professionals may disagree about whether to continue or discontinue life support for infants in the neonatal intensive care unit (NICU) when the infant has an extremely poor chance of survival and/or probably has profound neurological damage. Conflict usually occurs when the parents want everything possible done to keep their infant alive, while the medical team believes that continued care will only prolong suffering and consume resources needed for other patients. The argument is made that often insufficient time and effort is made to fully understand the parents' reason(s) for requesting continued life support. Instead, they are advised to stop support, the advice is rejected, and this results in conflict with the family. A case is used to illustrate this situation, and five typical reasons families have for requesting continued life support, against the advice of the infant's physician, are presented. Each reason needs to be explored and addressed differently. Full appreciation of the reason for the family's request can often prevent conflict between the physician and the family and replace it with support and understanding. Increased emphasis on educating physicians about how to conduct end-of-life discussions, making time for repeated family conferences, and use of a palliative care consultant, should be considered as ways to improve family-physician communication and prevent unnecessary conflicts.