The Place of Viability, Suffering, and Anomalies in Ethical Decision Making in a Neonatal Intensive Care Unit

Abstract

This ethnographic study explored the role of infant characteristics in the identification of a situation as ethical. Data, collected during a six-month field study, included observations, interviews, and chart, policy, and procedural manual review. Field notes and interview data were audiotaped, transcribed, and analyzed for patterns and negative exceptions. Perceptions of ambiguity about a baby's humanness affected the process of defining situations as ethical. Ethical discourse was most likely to occur about babies who were overtly anomalous. It was least likely to occur about babies who were significantly “objectified” but not anomalous. Objectification was mediated by staff perceptions about infant suffering. Determinations of infant nonviability, while not ignored, were neither necessary nor sufficient for ethical discourse to occur.