Journal of Bioethical Inquiry

, Volume 15, Issue 3, pp 319–325 | Cite as

Parental Moral Distress and Moral Schism in the Neonatal ICU

  • Gabriella Foe
  • Jonathan Hellmann
  • Rebecca A. GreenbergEmail author
Critical Perspectives


Ethical dilemmas in critical care may cause healthcare practitioners to experience moral distress: incoherence between what one believes to be best and what occurs. Given that paediatric decision-making typically involves parents, we propose that parents can also experience moral distress when faced with making value-laden decisions in the neonatal intensive care unit. We propose a new concept—that parents may experience “moral schism”—a genuine uncertainty regarding a value-based decision that is accompanied by emotional distress. Schism, unlike moral distress, is not caused by barriers to making and executing a decision that is deemed to be best by the decision-makers but rather an encounter of significant internal struggle. We explore factors that appear to contribute to both moral distress and “moral schism” for parents: the degree of available support, a sense of coherence of the situation, and a sense of responsibility. We propose that moral schism is an underappreciated concept that needs to be explicated and may be more prevalent than moral distress when exploring decision-making experiences for parents. We also suggest actions of healthcare providers that may help minimize parental “moral schism” and moral distress.


Decision-making Parents Neonatal intensive care Moral distress Bioethics 


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Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2018

Authors and Affiliations

  • Gabriella Foe
    • 1
  • Jonathan Hellmann
    • 1
    • 2
  • Rebecca A. Greenberg
    • 1
    • 2
    Email author
  1. 1.Bioethics DepartmentThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of PaediatricsUniversity of TorontoTorontoCanada

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