Ethical Issues in the NICU: The Importance of Team Education and Preparedness

Jonathan Fanaroff, MD, JD, FAAP, FCLM, professor of pediatrics at Case Western Reserve University School of Medicine, co-director of the Neonatal Intensive Care Unit at Rainbow Babies & Children's Hospital, and director of the Rainbow Center for Pediatric Ethics, discusses the medical, legal, and ethical dilemmas presented by critically ill infants admitted to the neonatal intensive care unit (NICU). Dr. Fanaroff uses a case-based approach to discuss common ethical dilemmas in the NICU, such as whether to offer feeding tubes to critically ill infants. He also offers strategies for improving communication between members of the health care team and between providers and parents about viability issues, withholding vs withdrawing treatment, and end-of-life care.

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  Jonathan Fanaroff, MD, JD, FAAP, FCLM

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  Jonathan M. Fanaroff, MD, JD, is director of the Rainbow Center for Pediatric Ethics and co-medical director of the Neonatal Intensive Care Unit at University Hospitals Rainbow Babies and Children'™s Hospital in Cleveland, Ohio, and associate professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland.

  Dr. Fanaroff obtained his medical degree and completed a pediatric residency at Case Western Reserve University School of Medicine. He completed an internship in obstetrics-gynecology at McGraw Medical Center of Northwestern University in Chicago, and a fellowship in neonatology by UH Rainbow Babies and Children's Hospital. He received his law degree from the University of Virginia School of Law in Charlottesville, Virginia, and an ethics fellowship from MacLean Center for Clinical Medical Ethics at the University of Chicago. His special interests are high-risk neonates and ethical and legal issues in their treatment.

  In 1969, Dr. Fanaroff's father, Avroy Fanaroff, MD, former chief of neonatology and chairman of pediatrics at UH Rainbow Babies and Children's Hospital, had just started a fellowship in neonatology at the hospital when his son, Jonathan, was admitted to the NICU for a three-week stay. Fast forward to 2012, and Dr. Jonathan Faranoff and his wife, Kristy Fanaroff, MSN, NNP, a neonatology nurse practitioner in the NICU, became the parents of Mason, a son born at 32 weeks and admitted to the NICU. The three members of the Fanaroff family are among the authors of the article "Stronger and More Vulnerable: A Balanced View of the Impacts of the NICU Experience on Parents" published in the September 2016 issue of the journal Pediatrics. Their professional and personal perspectives, that they willingly share with other providers, now help to guide the policies and procedures of the NICU at UH Rainbow Babies and Children's Hospital.

  Dr. Fanaroff has numerous other publications to his credit. He serves on the editorial board of ISRN Critical Care and is a reviewer for several medical journals, including Pediatrics, Journal of Pediatrics, Journal of Perinatology and Pediatric Research. A sought-after speaker, Dr. Fanaroff has presented on neonatal medicine and ethics to national and international pediatric medicine and nursing conferences.

  Dr. Fanaroff is chair of the American Academy of Pediatrics Committee on Medical Liability and Risk Management. He is a Fellow of the American Academy of Pediatrics (AAP) and the American College of Legal Medicine as well as a member of the Society for Pediatric Research, the Northeast Ohio Regional Pediatric Ethics Consortium and the Northeast Ohio Neonatology Group.

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  Jonathan Fanaroff, MD, JD, FAAP, FCLM

  Professor of Pediatrics 
  Case Western Reserve University School of Medicine
  Co-Director, Neonatal Intensive Care Unit
  Rainbow Babies and Children's Hospital / UH Case Medical Center
  Cleveland, Ohio