Clinical Assistant Professor Nationwide Children's Hospital/The Ohio State University College of Medicine Plain City, Ohio
Abstract: Goals-of-care discussions in the neonatal intensive care unit (NICU) are often emotionally charged and ethically complex. Clinicians may struggle to balance medical guidance with parental authority, particularly when intensive interventions are unlikely to change an infant’s outcome. Parents in these situations ask, “Are we making the right decision?” or “Are we causing our baby to suffer?” – struggling to shoulder the responsibility of making an explicit, burdensome choice to allow a natural death for their child.
Informed non-dissent is a proposed approach of shared decision-making which allows clinicians to recommend a medically appropriate course of action while observing for parental discomfort or objection, rather than requiring explicit agreement. This strategy can be particularly effective in emotionally-charged, end-of-life situations, when continued interventions are non-beneficial or when transitioning to comfort-focused care is the most compassionate option. Parents may indirectly express readiness to redirect care goals, but feel unable to make that decision themselves. By reducing the weight of decision-making on parents, it prevents decisional paralysis and moral distress while preserving parents’ role in decision-making and their child’s care, and improve alignment between parental wishes and medical outcomes.
This session will critically examine benefits of an informed non-dissent approach while also addressing potential pitfalls. This strategy must be applied carefully to avoid risks to parental authority and ensure families remain active participants in their child’s care. Through case-cased discussion, we will explore when and how this approach can be effectively applied to support goals-of-care conversations, offering strategies to improve communication and support families.
Keywords: decision-making, goals of care, neonatal intensive care
Learning Objectives:
After participating in this conference, attendees should be able to:
Examine current approaches to conversations surrounding goals-of-care in the NICU and how they may place undue burden on parents and contribute to clinician moral distress
Explore the use of an informed non-dissent approach in cases where continued intensive interventions are unlikely to result in survival, reducing burden while maintain parental involvement
Develop effective communication strategies to guide conversations and decision-making surrounding goals-of-care for critically ill newborns using an informed non-dissent approach
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