Table 4. Perceived versus reported confidence navigating various ethical challenges
common to the NICU.
Ethical Challenge
1. Identifying proper decision maker(s) for a
patient in the NICU
2. Delivering bad news to families
3. Administering opioids for symptom relief
near the end of life
4. Deciding about withdrawing assisted
ventilation for patients in the NICU
5. Deciding about withdrawing artificial
nutrition and hydration for patients in the
NICU
6. Discussing Do-Not-Resuscitate orders
with parents of a terminally ill infant
7. Requesting permission for organ donation
from the parents of an infant diagnosed with
brain death
8. Requesting permission for autopsy from
the parents of an infant who has died
9. Discussing with parents prenatally
whether to attempt resuscitation for a
premature infant near the margin of viability
10. Deciding whether to respect an
adolescent parent’s refusal of recommended
care for their newborn
11. Making decisions about life-sustaining
therapies for infants with potentially severe
neurocognitive disabilities
12. Discussing newborn screening with
parents of a newborn infant
13. Counseling families about an emerging
therapy as a potential treatment option
14. Obtaining parents’ permission to enroll
an infant in a clinical trial
15. Performing a blood draw on an infant
for purely research purposes
16. Weighing the cost of therapy in deciding
on treatment options for an individual
patient
17. Weighing authors’ financial
relationships with study sponsors when
reading reports of clinical trials
18. Responding to offers of gifts from
representatives of the pharmaceutical
industry
19. Receiving medical information from
representatives of the pharmaceutical
industry
Perceived Confidence
(PDs)
Ext
Mod
SW/
Conf/ Conf
Not
Conf
37
5
4
(80.4) (10.9) (8.7)
39
4
3
(84.8) (8.7)
(6.5)
38
5
3
(82.6) (10.9) (6.5)
36
7
3
(78.3) (15.2) (6.5)
19
12
15
(41.3) (26.1) (32.6)
Reported Confidence
(NPFs/ECNs)
Ext
Mod
SW/
Conf/ Conf
Not
Conf
71
6
5
(86.6) (7.32)
(6.1)
68
9
5
(82.9) (10.9)
(6.1)
67
13
2
(81.7) (15.9)
(2.4)
52
20
10
(63.4) (24.4) (12.2)
24
24
34
(29.3) (29.3) (41.5)
39
(84.8)
25
(54.3)
6
(13.0)
9
(19.6)
1
(2.2)
12
(26.1)
59
(71.9)
43
(52.4)
15
(18.3)
19
(23.2)
8
(9.8)
20
(24.4)
0.1705
36
(78.3)
38
(82.6)
7
(15.2)
6
(13.0)
3
(6.5)
2
(4.4)
62
(75.6)
65
(79.3)
14
(17.1)
12
(14.6)
6
(7.3)
5
(6.1)
0.9439
22
(47.8)
13
(28.3)
11
33
(23.9) (40.2)
25
(30.5)
24
(29.3)
0.6864
37
(80.4)
8
(17.4)
1
(2.2)
42
(51.2)
31
(37.8)
9
(11.0)
0.0040
36
(78.3)
31
(67.4)
34
(73.9)
30
(65.2)
24
(52.2)
7
(15.2)
11
(23.9)
8
(17.4)
9
(19.6)
13
(28.3)
3
(6.5)
4
(8.7)
4
(8.7)
7
(15.2)
9
(19.6)
66
(80.5)
45
(54.9)
46
(56.1)
38
(46.3)
33
(40.2)
12
(14.6)
23
(28.1)
18
(22.0)
21
(25.6)
25
(30.4)
4
(4.9)
14
(17.1)
18
(22.0)
23
(28.1)
24
(29.3)
0.9182
25
(54.4)
15
(32.6)
6
45
(13.0) (54.9)
22
(26.8)
15
(18.3)
0.6580
17
(47.2)
13
(36.1)
6
52
(16.7) (63.4)
20
(24.4)
10
(12.2)
0.2567
28
(60.9)
12
(26.1)
6
43
(13.0) (52.4)
26
(31.7)
13
(15.9)
0.6544
p
0.6545
0.9178
0.4105
0.2172
0.3715
0.8917
0.8786
0.2956
0.0902
0.1051
0.3557
20. Disclosing medical error
33
(71.7)
42
(91.3)
40
(87.0)
38
(82.6)
10
(21.7)
3
(6.5)
5
(10.9)
7
(15.2)
3
(6.5)
1
(2.2)
1
(2.2)
1
(2.2)
46
(56.1)
74
(90.2)
71
(86.6)
62
(75.6)
28
(34.2)
7
(8.5)
10
(12.2)
15
(18.3)
8
(9.8)
1
(1.2)
1
(1.2)
5
(6.1)
0.2171
21. Obtaining informed consent/permission
0.8485
from parents
22. Shared decision-making in the best
0.8974
interests of the patient
Overall confidence in your/your fellows’
0.5182
ability to address the ethical challenges that
arise in practice in the NICU?
PDs=Program Directors; NPFs=Neonatal-Perinatal Fellows; ECNs=Early Career Neonatologists.
Ext Conf=Extremely Confident; Conf=Confident; SW=Somewhat Confident; Not=Not At All Confident