Cover

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Frontmatter

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Contents

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pp. v-vi

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Acknowledgments

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pp. vii-x

The process by which a book comes into being is mysterious. This one began 15 years ago as a series of conversations and inquiries into the decision-making process in neonatal intensive care units. We began collecting data and presenting analyses at various scientific meetings, in particular the Society for Pediatric Research and the American Society of Bioethics and Humanities. Generous grant ...

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1 Overview and Introduction

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pp. 1-12

For the past half-century, the field of neonatology has grown and matured, like a baby in an incubator, in the strangely closed world of neonatal intensive care units (NICUs). Rarely have the processes and products of scientific medicine been as heralded and harangued, as lauded and condemned, as publicized and misunderstood as they have in the context of NICUs. In this book, we examine the creation and ...

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2 Some Facts about Infant Mortality and Neonatal Care

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pp. 13-17

Neonatal mortality is defined as death before 28 days of age. Postneonatal mortality is defined as death between 28 days and 1 year. Infant mortality is the sum of these two and is defined as death before 1 year of age. ...

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3 The Era of Innovation and Individualism, 1965–1982

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pp. 18-52

The story of clinical innovation in medicine is often frightening. It involves a certain degree of hubris. Innovators must think that they can use science, cleverness, and narcissistic grandiosity to improve on tradition. Such adventures often end badly. They are usually stories of fits and starts; of irrational exuberance and of avoidable tragedy; of skill, luck, science, and serendipity. Sometimes, they involve...

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4 The Era of Exposed Ignorance, 1982–1992

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pp. 53-84

This decade saw widespread medical, political, and legal controversy following the death of a baby, Baby Doe in Bloomington, Indiana. Before telling that story, however, we review the medical developments that set the stage for the national controversy. Medical advances during the first era of neonatology were characterized by the development of two key therapeutic interventions: mechanical ...

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5 The End of Medical Progress, 1992 to the Present

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pp. 85-121

During the first era of neonatology, the will to innovate led to the discovery of new knowledge and the creation of both new technologies and new administrative structures. These, in turn, led to a second era in which the focus shifted from exuberant innovation to a refinement of both the technologies and the societal mechanisms by which the use of the technologies was governed. Attempts to regulate ...

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6 Economics of the NICU

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pp. 122-135

The central question of NICU economics (and, perhaps, of all economics) is about comparative value. In economic terms, it might be phrased, “Is the product worth the cost?” With regard to NICUs, that question can be unpacked into a series of subtler questions. What, exactly, is the “product” of neonatal intensive care? How much does it really cost? Who will bear the cost? Who will benefit? ...

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7 Four Discarded Moral Choices

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pp. 136-149

This book recounts and analyzes the complex, forty-year-long process by which moral consensus developed in the United States about certain aspects of neonatology. The complexity of the process reflects the nature of the problems. They were problems that touched areas of human existence, such as pregnancy, birth, and the intensive medical care of newborn babies, that had never before been the subject of ...

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8 The Possibility of Moral Progress

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pp. 150-158

A cartoon compares science and ethics. In the top half, there is a picture of aquadruped, walking across the frame from left to right. In each successive frame, the creature evolves. He begins as a small ape, becomes half-human, then a primitive human, and finally a civilized, well-dressed modern man. This part of the cartoon is labeled “Science.” The bottom half of the cartoon shows the same quadruped ...

Notes

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pp. 159-172

Index

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pp. 173-179