As the neonatal intensive care nursery gives rise to many potentially painful procedures, a dilemma exists for caregivers in assessing if sick and/or premature infants are in pain (Nagy 1998). Although newborn pain affects the short-term interests there are possibilities that the lasting effects may also be harmful (Spence, 2000). For a long time, the medical profession has given its members with the knowledge and skills that are required to treat disease and deformity. Physicians have often been the front line of technological mastery, increasingly emotional with the onerous responsibility of determining when intervention is suitable. Underlying this responsibility is a foundation of core principles, including beneficence, non-malfeasance, and compassion. Conscious use of these principles is not often supportive when the best interests of patients are diverse and apply to many relevant but competing parties. The dispute of applying center principles to complex cases at the beginning of life can confidently engage the morality and empathy of the contemporary medical enterprise (Morrow, 2000).

Clinical encounters for parents are often new and harsh experiences, where expectations and prospects of health and happiness can be endangered by the birth of even a mildly deformed or impaired child. Parents are almost always ill-equipped for premature or hazardous delivery. They often feel mistreated, surprised, mad, and culpable. They may feel undeserving or incapable to assume the role of caregiver. In negotiating the details of intensive care, neonatologists may confuse parents and thereby distort the balance of power. Therefore, empathy is chief when they deliver clinical decisions. Neonatologists must anticipate the vulnerability of parents, collaborate with them, and gently guide them through their decision, especially when parents are hostile or recalcitrant (Morrow, 2000).

All physicians should talk about the standards of care appropriate to similar clinical situations. For instance, failure to treat an infant with a mild case of Down syndrome and correctable intestinal atresia is inconsistent with best medical practice and thus neglectful. Useful and comforting actions a physician can use include introducing parents to families who have come upon similar dilemmas, and connecting them with outreach organizations that help parents raise children with special needs. Likewise, searching for adoptive parents may disclose an abundance of families who are willing to raise such a child, which in turn would seem to weaken the moral acceptability of hastily employing selective infanticide (Morrow, 2000).

The moral difficulties of Baby Doe have required physicians to deliberate the most accountable ways to put into practice new technologies. Federal regulations have often had significant resistance, especially by physicians who think that the medical profession can meet the moral disputes of medicine without duress. Such optimism is warranted if physicians fulfill their duty to explain to the public the ineradicable presence of disease, disability, and less-than-maximum utility in our society. At that point in time, they keep hold of the right to advocate for the sensible and compassionate use of life-saving intercessions. When physicians employ in collective moral communication they can create successful therapeutic alliances with their patients and their patients' families. Then, with collaborative and empathetic decision-making, they will make an increasingly crowded NICU a good place to live (Morrow, 2000).

Counselor involvement with families of severely disabled infants calls for consideration...

In ethical codes for counselors and psychologists, no standard exists that relates to life or death decisions. Standards that relate to promoting client welfare and protecting clients and others from physical and psychological trauma may be generalized to this issue. Although the decision considered by parents focuses upon the infant, the parents are the actual clients of the counselor. Rather than allowing counselor values to influence the decision process, it is appropriate that the counselor support the parents in their own decisions, which must be made within a brief period of time. This time frame also does not allow counselors to work through their own ethical dilemmas before becoming involved with an infant's family (Head, Head, and Head, 1985).
In assisting parents to consider options relative to the birth of a severely disabled child, counselors must call upon a delicate balance between the most empathic humanistic concern and the cold reality of information that the parents should consider. Obviously, the most immediate aspect for parental consideration is whether to allow extraordinary means of sustaining their infant's life. Not only is this decision devastating and often unthinkable to parents, but the counselor may feel overwhelmed in discussing aspects of it (Head, Head, and Head, 1985).

Throughout the decision making process, parents need the understanding and support of basic to all positive counseling relationships. They also need to receive and process new information. A tremendous increment of difficulty is added by the limited time frame in which a decision must be made. If counselors are to offer assistance to these parents or family members, they must have information and an appropriate frame of references before the time of crisis.

Specific guidelines for assisting counselors in consideration of this issue are difficult to propose. This issue is highly personal and influenced by emotions and values. It is hoped that counselors may subordinate the influence of their own value system and offer support for a decision that benefits a particular infant and family (Head, Head, and Head, 1985). The bottom line in these situations is that parents who are placed into the situation of making a decision in regards to a critically impaired child is a very difficult one at best. These parents are often in need of a lot of help and advice in order to understand the situation that they are dealing with. No matter who they are seeking advice from it is very important that the advice is given to them in the most ethical way possible so that it is ensured that the best decision is made.

References

Head, David W., Head, Becky and Head, James L. (1985). Life or Death of Severely Disabled

Infants: A Counseling Issue. Journal of Counseling & Development. 63(10), p. 621.

Kopelman, Loretta M. (2005). Are the 21-Year-old Baby Doe Rules Misunderstood or Mistaken? Pediatrics. 115(3), pp. 797-802.

Morrow, Jason. (2000). Making Mortal Decisions at the Beginning of Life: The Case of Impaired and Imperiled Infants. Journal of American Medical Association. 284, p. 1146-

Spence, Kaye. (2000). The best interest principle as a standard for decision making in the care of neonates. Journal of Advanced Nursing. 31(60, p.1286-1292.

Vrakking, Astrid M., van der Heide, Agnes, Onwuteaka-Philipsen, Bregje D., Keij-Deerenberg,

Ingeborg M., van der Maas, Paul J. And van der Wal, Gerrit. (2005). Medical end-of-life decisions made for neonates and infants in the Netherlands, 1995…