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Attitudes of mothers, doctors, and nurses toward neonatal intensive care in a developing society
1Department of Paediatrics, University of the Witwatersrand, Baragwanath Hospital, Soweto, South Africa.
Background:
The ethical allocation of scarce resources is a major challenge for physicians working in the developing world. Guidelines currently employed by health care workers in the developed world may be considered impractical or inappropriate in the "Third World."
Objective:
To gain insight into the attitudes of doctors, nurses, and mothers of recent neonatal intensive care unit (NICU) survivors toward the utilization and withdrawal of life support in the context of a developing society.
Design:
Descriptive cohort study.
Participants:
Thirty-three doctors, 20 nurses, and 70 mothers of recent NICU survivors. The cohort of mothers surveyed were predominantly unmarried, poorly educated, and either unemployed or still at school.
Results:
In response to hypothetical scenarios, mothers exhibited very conservative attitudes toward withdrawal of life support compared to caregivers. Only 2.9% (2/70) of mothers would contemplate any degree of life support withdrawal for infants with probable "moderate" handicap compared with 51.0% (26/51) of the medical staff. One mother (1.4%, 1/70) accepted the concept of withdrawal of life support where extremely poor outcome was anticipated, compared with 85% (45/53) of the caregivers. Doctors and nurses exhibited very utilitarian attitudes toward NICU resource allocation, with emphasis directed toward avoidance of significant handicap. The majority of these caregivers considered the anticipated burden of the handicapped child in the society to be a major factor in the justification of their decision.
Conclusion:
The nonideal conditions under which doctors and nurses work in developing nations mandate resource allocation to be an integral component of NICU care.