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Neonates as intrinsically worthy recipients of pain management in neonatal intensive care

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Abstract

One barrier to optimal pain management in the neonatal intensive care unit (NICU) is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are (1) vulnerable to pain and harm, and (2) completely dependent on others for pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate’s family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers.

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Funding

Emre Ilhan was supported by an Australian Government Research Training Program (RTP) Scholarship.

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Authors and Affiliations

  1. Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia

    Emre Ilhan, Verity Pacey, Laura Brown, Kelly Gray, Jennifer E. Rowland & Julia M. Hush

  2. Children’s Hospital at Westmead, Grace Centre for Newborn Intensive Care, Sydney, NSW, Australia

    Kaye Spence

  3. School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia

    Kaye Spence

  4. Research Ethics and Integrity, Macquarie University, Sydney, NSW, Australia

    Karolyn White

  5. Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW, 2109, Australia

    Emre Ilhan

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  1. Emre Ilhan
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All authors contributed to the conception of the work. The first draft was written by Emre Ilhan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript

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Ilhan, E., Pacey, V., Brown, L. et al. Neonates as intrinsically worthy recipients of pain management in neonatal intensive care. Med Health Care and Philos 24, 65–72 (2021). https://doi.org/10.1007/s11019-020-09982-z

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