Mixed Blessings: Intensive Care for Newborns

In just a decade's time, intensive medical care for newborns has changed from an experimental venture to a widespread and often controversial hospital service. The cost of newborn intensive care ranks among the top three medical expenses in this country, and while the legal and ethical issues of treating critically ill infants parallel those of adult patients, even more troublesome is the issue of family versus physician control of hospital technology. In this first inside account of the closed world of neonatal intensive care, two medical sociologists focus on the social context for medical decision making in the sensitive area of newborn life. Based on observations in the most sophisticated neonatal intensive care units in twelve U.S. hospitals, this work explores the diverse experiences and perspectives of the parents, and all involved hospital personnel. Giving particular attention to how physicians and nurses approach clinical work, they raise sensitive questions and issues that are part of the fabric of neonatal care, questions such as: When should a baby be moved into--or out of--an intensive care unit? How much help should be given? To what extent are parents regularly excluded from decisions made about the fate of their child? The result is an enthralling ethnography with findings both fascinating and eye-opening. In the final chapters the authors offer policy recommendations that address the social and professional problems associated with newborn intensive care. This controversial new field of medical care is of increasing public concern as more and more babies are entering intensive care units and the previous limits of human life are being continually challenged and extended.