One barrier to optimal pain management in the neonatal intensive care unit is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are vulnerable to pain and harm, and completely dependent on others for (...) pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate’s family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers. (shrink)

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show (...) that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined. (shrink)

In accepting the invitation of your society to discuss some aspects of the philosophy of science, particularly as they might bear on the problems of an experimental psychologist, I should like from the start to make it very clear that I do not consider myself a philosopher, not even an amateur one. Like most empirical scientists, particularly of the laboratory variety, I usually take it for granted that my world is real and that the things I perceive as existing in (...) it can be investigated by my empirical methods. I seem to get along quite well with this unpremeditated, common-sense realism, and, for the most part, I go along minding my own experimental business. As the psychologists among you may know, however, every once in a while I seem to have to abandon this happy, naive state and let myself get involved in questions about my science, the kinds of questions that are more properly the business of the philosopher of science. (shrink)