Physicians have often been the vanguard of technological mastery, increasingly charged with the onerous responsibility of determining when intervention is appropriate. Unfortunately, conscious use of these principles is not often helpful when the best interests of patients are varied and apply to many relevant but competing parties. The challenge of applying core principles to complex cases at the beginning of life can hopefully engage the morality and empathy of the modern medical enterprise. Neonatologists spend their careers in the NICU, but it is a foreign world to most people. Clinical encounters for parents are often novel and jarring experiences, where hopes and expectations of health and happiness can be threatened by the birth of even a mildly deformed or impaired child.
Parents are almost always unprepared for premature or hazardous delivery.
They often feel victimized, shocked, angry, and guilty. In negotiating the details of intensive care, neonatologists may confuse parents and thereby distort the balance of power. Neonatologists must anticipate the vulnerability of parents, collaborate with them, and gently guide them through their decision, especially when parents are hostile or recalcitrant. All physicians should discuss the standards of care appropriate to similar clinical situations. Useful and comforting measures a physician can initiate include introducing parents to families who have encountered similar dilemmas, and connecting them with outreach organizations that help parents raise children with special needs.