Background: Benevolent injustice
occurs when well-intentioned treatment efforts produce an outcome that limits the potential of a patient. The unintended harm can result in significant moral distress
for the family and the healthcare team.
We discussed an ethical dilemma regarding a neonate
who had suspected seizure and hypoxic–ischemic encephalopathy after home birth delivery. The healthcare team experienced moral distress
about the mother's desire to not use anti-seizure medications and instead trial other interventions such as cuddling. Subsequently, clinical analysis ruled out a seizure disorder. Genetic studies on this neonate
confirmed hereditary hyperekplexia
, which presented as exaggerated Moro reflex and apnea that mimicked seizure.
We discussed how applying any one of the 4 basic ethical principles of autonomy, beneficence, nonmaleficence, or justice could counteract benevolent injustice
and moral distress
Discussions with the patient's mother and nurse allowed the team to overcome their reluctance to try the mother's treatment recommendations. This resulted in adopting the seemingly counterintuitive intervention of cuddling that turned out to be effective for this neonate
with hereditary hyperekplexia
The moral distress
associated with benevolent injustice
should be identified early to minimize long-term consequences to the patient, family, and healthcare team. Healthcare teams should learn to apply ethical principles when discussing patient care concerns in an unbiased manner. Guided ethical discussions allow us to be more efficient in providing family-centered care that aligns with the patient's best interest.