1. Beal, Judy DNSc, RN

Article Content

Catlin, A., Volat, D., Hadley, M. A., Bassir, R., Armigo, C., Valle, E., et al. (2008). Neonatal Network, 27, 101-108.


In this call to action for neonatal nurses, the authors report on a concept analysis and subsequent pilot study examining conscientious objection as a potential response to the moral distress felt by neonatal nurses when unwarranted or futile care, especially technological intervention, is provided for newborns who have conditions incompatible for life. An extensive review of the literature was done on moral distress, futile care, and conscientious objection, including nursing literature. "For the nurse, conscientious objection may occur when the nurse interprets that the care that has been assigned for a patient is harmful or causing suffering. The nurse does not want to provide this care and feels sincerely and has felt for some time that this is a question of conscience. The nurse objects to the nature of the care orders, willing to assist in other forms of care and not wishing to abandon the patient" (p. 105-106).


A small pilot study next examined the relevance of the newly defined concept for practicing nurses. Sixty-six neonatal (53 or 80%) and pediatric critical care (13 or 20%) nurses who reported caring for critically ill neonates were surveyed. Most of the nurses (52%) reported that they had or would have liked to have objected to futile interventions; 41% specifically identified those interventions as technological interventions for 22- to 24-week gestational age newborns and others with conditions that are incompatible with survival. Many expressed a desire to object to the pressure from parents to keep their baby alive. When they wanted to object but did not, participants reported feeling helpless, powerless, angry, and frustrated. Almost half reported that they had acted in a way that could be considered conscientious objection. Many barriers to objecting were cited, including physician orders, administrative policies, legal consequences, undue parental pressure, and concerns about job ramifications. The authors concluded with a call to action for all nurses working with this vulnerable population. Further ongoing dialogue was encouraged, as was unit-based discussion. Will you respond to this call? Read more in this very interesting article.


Judy Beal




National Association of Neonatal Nurses. (2007). NICU nurse involvement in ethical decisions (treatment of critically ill newborns). Position paper 3015, revised. Glenview, IL: NAAN.