The Ethics of Dnr Orders as to Neonatal and Pediatric Patients: The Ethical Dimension of Communication

Abstract

In this paper, I examine some of the ethical issues of DNR orders as they pertain to neonatal and pediatric patients. While ethical controversy over DNR orders is hardly novel, I argue that there are good reasons for thinking that at least some of the moral problems that arise as to DNR orders for neonatal and pediatric patients are unique, i.e., that neonatal and pediatric patients are ethically sui generis. Using case studies, I examine some of the reasons why the ethical issues are unique, which center around the idea that infants and children are seen as just beginning their life span. I attempt to show how the perception that infants and children are sui generis exacerbates general problems with DNR orders, and conclude that these difficulties make the painful task of communicating with parents or surrogates about DNR status an ethical imperative. Finally, I suggest that the primary canons of loyalty are owed from the physician to the patient, and that reflexive obeisance to parental wishes may not be the ethically wisest course of action with regard to the neonatal or pediatric patient.

Keywords: clinical, ethics, bioethics, DNR, order, end-of-life, neonatal, pediatric