ABSTRACT
Perplexing prognoses introduce additional dilemmas into the decision-making process, for they demand that physicians consider what level of certitude is required to reach a life-and-death decision and by what standards relative certitude should be established. The life-and-death decision is a complex social activity that embraces several participants: attending neonatologists, consultants, residents, fellows, nurses, and parents. Much of the literature on the ethics of neonatal intensive care individuals the decision-making process, obscuring not only the way in which decisions are reached but the social context in which they take place. Life-and-death decisions are also influenced by developments outside the walls of the intensive-care nursery. Shifting legal rulings, articles in the mass media, and public policy pressures toward cost containment—to name a few of the more obvious developments—conspire to create a wider climate in which decisions must be reached. Life-and-death decisions are not merely matters of individual conscience but, rather, take place within the context of organizations, institutions, and power relationships.
