Pursuing the golden mean ‑ moral decision making for precarious newborns

Abstract

Objective: To demonstrate a need, and develop a process, for moral decision making regarding precarious newborns.

Setting: The Neonatal Intensive Care Unit (NICU).

Primary argument: This paper argues that it is imperative for healthcare institutions to develop a formal process of ethical review for decision making regarding precarious newborns. Broadly, precarious newborns are those that fall into the following two categories:

• babies with congenital anomalies which are either life threatening or which pose a risk of significant morbidities; and


• extremely premature babies who are otherwise physically normal.

After identifying some of the reasons why decision making regarding these infants is particularly fraught, some examples are used to draw out the problems which arise in the absence of a formal decision making process.

Conclusion: Aristotle’s metaphor of the golden mean provides a framework for a moral decision making process which can be beneficially utilised in complex cases involving precarious newborns. The decision making process advocated in the paper is briefly characterised as a cooperative discursive one, based on inclusive representation and underpinned by core ethical principles such as non‑maleficence, beneficence, justice, and transparency.