Parental Moral Distress and Moral Schism in the Neonatal ICU

Area of Science:

• Medical Ethics
• Neonatal Intensive Care
• Psychology

Background:

• Healthcare practitioners often experience moral distress due to ethical dilemmas in critical care.
• Paediatric decision-making frequently involves parents, particularly in neonatal intensive care units (NICUs).

Purpose of the Study:

• To propose and define a new concept, "moral schism," experienced by parents in the NICU.
• To differentiate "moral schism" from moral distress in the context of parental decision-making.
• To explore factors contributing to parental moral distress and "moral schism" and suggest interventions.

Main Methods:

• Conceptual exploration and definition of "moral schism" based on existing literature on moral distress.
• Identification of contributing factors such as support, coherence, and responsibility.
• Proposal of healthcare provider actions to mitigate these experiences.

Main Results:

• Parents in the NICU can experience "moral schism," characterized by genuine uncertainty and emotional distress during value-based decisions.
• "Moral schism" arises from internal struggle, not external barriers, distinguishing it from moral distress.
• Factors like support, situational coherence, and responsibility influence both parental moral distress and "moral schism".

Conclusions:

• "Moral schism" is an underappreciated and potentially prevalent concept in parental NICU decision-making.
• Healthcare providers can implement strategies to minimize parental "moral schism" and moral distress.
• Further explication of "moral schism" is needed to understand its prevalence and impact.