The Ethics of Proximity: Bedside Ethics and the Contribution of NICU Nurses to Ethical Deliberation

Background/Objectives: Ethical decision-making in neonatal intensive care units (NICUs) requires the integration of clinical evidence, prognostic evaluation, and relational perspectives to determine the newborn’s best interests. Pellegrino’s concept of bedside ethics emphasizes the moral significance of proximity and the knowledge generated through the clinical encounter. However, the specific contribution of NICU nurses to ethical deliberation remains insufficiently explored. This conceptual article aims to explore the contribution of NICU nurses to multidisciplinary ethical deliberation and shared decision-making, focusing on how bedside presence and relational proximity inform ethical reflection and clinical decisions. Methods: A literature-informed approach was conducted to synthesize empirical studies, theoretical contributions, and academic literature addressing the ethical role of NICU nurses. A literature search was conducted between April and July 2026 in PubMed and Scopus using terms related to neonatal intensive care, nursing, ethics, ethical decision-making, bedside ethics, shared decision-making, clinical ethics consultation, and moral distress. Eligible publications included empirical studies, reviews, theoretical papers, and one professional position statement. Sources were analyzed through an iterative conceptual synthesis. Results: Four interconnected dimensions of NICU nurses’ ethical contribution were identified: the epistemic, dialogical and advocacy, integrative, and educational roles. Nurses’ continuous bedside presence generates longitudinal knowledge of the newborn’s clinical condition, suffering, comfort, and family dynamics, enriching ethical deliberation beyond biomedical assessments. Conclusions: NICU nurses should be recognized as essential participants in ethical deliberation. Their proximity to the newborn represents not only an ethical responsibility but also an epistemic resource. Systematic inclusion of bedside nurses in multidisciplinary ethics discussions and Clinical Ethics Consultation processes is essential to promote ethically robust, relational, and patient-centered decision-making.