Ethical issues in NICUs: The Attitude of Greek Healthcare Professionals Towards the Value of Human Life

Abstract

Objective: This paper presents the first Greek empirical research on bioethical neonatal issues. The study goals were: 1) to document and measure the attitude of Greek healthcare professionals' working in NICUs towards the value of human life (intrinsic value vs. quality of life) as ethical decision making guiding principle in the provision of intensive treatment to extremely/very preterm babies and 2) to investigate the socio-cultural and other parameters which form this attitude. Methods:Questionnaires developed for the EURONIC project and implemented in research in 11 countries were culturally adjusted to the Greek NICU context. Healthcare professionals (n=495) who were employed in Greek NICUs (May 2009-May 2011 and met inclusion criteria were invited to participate. Of those 251 (98 midwives, 82 nurses and 71 doctors) completed a structured, self-administered, anonymous questionnaire (response rate 50.7%). Results:The reported attitude score (total sample mean attitude score=3.09) indicates that Greek healthcare professionals tend to support the intrinsic value of human life position. Gender (p<0.05), the importance placed on religion (p<0.05) and profession specialization (p<0.01) were found to influence their attitude in statistically significant ways. Specifically, men, professionals who consider religion as being important in their life and midwives and nurses tend to be more supportive of the intrinsic value of life position. NICUs' equipment and personnel, the cost of neonatal healthcare provision, and the burden of disability on the neonate's family have not been found to influence healthcare professionals' attitude in statistically significant ways. Conclusion:Compared to the findings from other countries in which the EURONIC research was implemented, Greek healthcare professionals appear to hold a rather vitalistic approach and follow the intrinsic value of human life position as their ethical decision-making guiding principle. Socio-cultural and professional characteristics explain ethical decision making differences among healthcare professionals.

Neonatal End-of-Life Decision Making: The Possible Behavior of Greek Physicians, Midwives, and Nurses in Clinical Scenarios

“…On the other hand, Greek healthcare professionals’ strong support towards sustaining the neonates’ life is in complete agreement with findings from other parts of our research. As reported in Daglas et al [ 45 ], Greek NICU healthcare professionals closely align with the argument of the intrinsic value of human life, even in the case of unfavorable prognosis. Their vitalistic approach far exceeds respective findings for any other country in Europe or internationally.…”

“…In the context of our research, the reliability of the scale was found to be high (Cronbach’s alpha = 0.77). Details on the translation and cultural adaptation of this scale for the Greek population have been presented elsewhere [ 45 ].…”

Bioethical Decisions in Neonatal Intensive Care: Neonatologists’ Self-Reported Practices in Greek NICUs

“…This study investigates aspects of the ethical decision-making process regarding provision of intensive care to babies born at the limits of human viability or suffering from a severe disease based on the internationally recognized research protocol of the EURONIC Project ("Parents' Information and Ethical Decision Making in Neonatal Intensive Care Units: Staff Attitudes and Opinions") [49]. The overall study's objectives and methods have been presented in detail elsewhere [48,50]. The current article presents findings on physicians' self-reported practices and their experience on ethical decision-making in clinical cases in which the infant (a) was near death and/or, (b) had a severe neurological prognosis.…”

Physicians’ attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey

“…Daglas et al [ 21 , 22 ] study on the attitude of Greek healthcare professionals in NICUs reported a mean attitude score of 3.1 indicative that Greek healthcare professionals tended to support the value of human life. Contrarily, our study reports an average attitude score of 5.8 indicative of a shift towards the value for quality of life.…”

“…EoL decisions are difficult to implement, therefore comparison with neonatologists’ applied practices in other countries is always useful [ 9 , 19 , 20 ]. There are two studies on healthcare professionals’ attitudes in Greek NICUs, referring to data from the same survey collected a decade ago [ 21 , 22 ]. The present nationwide multicenter survey was conducted to estimate, on a more representative basis, and evaluate possible differences in EoL decisions through the elapsed time.…”