The pivotal role of clinical ethics consults in critical clinical decision making in the Neonatal Intensive Care Unit within an Arab culture

Abstract

Medical Ethics is a relatively new field in developing countries and, to date, Lebanon is the only Arab country that offers bedside ethics consults; however, this is limited to a single medical center, the American University of Beirut Medical Center (AUBMC). The clinical ethicist running the bedside clinical ethics service was trained in the United States and the United Kingdom. However, once she began practicing in Lebanon, she realized that much of what she learned in terms of theory and practice as well as navigating ethical issues did not apply to the local context. Rather, much needed to be sifted and adapted to a different culture, social decorum, and mentality. This is more evident when working with patients in the Neonatal Intensive Care Unit (NICU), where parents coming from various areas in the region bring in their unique values and beliefs.
The admission of a premature newborn to the NICU is often a strenuous experience for parents and a challenge for healthcare providers. Ethical conundrums often arise when there is a potential partial success with a plan of treatment(s). For example, from an ethical point of view resuscitation is less problematic than surviving severe illness with brain damage, and thus controversial issues linked to quality of life surface as living in a vegetative or incapacitated state can be deemed worse than death. In this article, we present our own experience as neonatologists and clinical ethics consultant (CEC) teaming up at the AUBMC’s NICU in an attempt at navigating the muddy waters of decision-making and ethical controversies within an Arab culture characterized with specificities that are often neglected and thus might negatively impact the decision regarding the right plan of treatment. The aim is trying to come up with a recommendation that is in the best interest of the infant and his/her parents and in an attempt to ensure that parents understand the importance of them being part of the decision-making process.