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Ethical Dimensions of Neonatal Intensive Care: An Organizational Perspective Open Access


Other title
neonatal ethics
organizational ethics
moral distress
healthcare ethics
Type of item
Degree grantor
University of Alberta
Author or creator
Duthie, Katherine M
Supervisor and department
Greiner, Glenn (School of Public Health; Philosophy)
Examining committee member and department
Storch, Jan (Faculty of Nursing, UVic)
Rondeau, Kent (School of Public Health)
Mumtaz, Zubia (School of Public Health)
Shanner, Laura (community member)
Byrne, Paul (Faculty of Medicine)
Austin, Wendy (Faculty of Nursing)
Department of Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
In this dissertation, I explore how a health organization’s function affects the moral dimensions of care within its neonatal intensive care unit (NICU). Understanding this relationship reveals a broader view of the ethical challenges of neonatal intensive care, which enables a more coherent understanding of the moral consequences of the practice, and highlights unacknowledged types of moral duties in healthcare. This study uses methodological elements of Institutional Ethnography (IE) to collect data using a combination of formal and informal observation, and guided interviews with healthcare providers, managers, and high-level administrators. The research offers original contributions to knowledge in two areas. Within the context of neonatal health care it clarifies the moral world for those delivering neonatal care by showing the moral consequences of practice directives (a.k.a. policy) use and variation (of people, attitudes and practice). This research also points to the underlying issue of uncertainty as a source of harm and distress for neonatal healthcare providers. As a contribution to understanding of healthcare organizational ethics, it offers an account of the interplay between organizational and clinical ethics that challenges the common view that organizational ethics has a top down relationship with clinical ethics. By identifying uncertainty as something created by organizational processes and that is a source of harm and suffering for neonatal healthcare providers, I argue that minimizing avoidable uncertainty among health care providers is a duty for organizations, and therefore is a matter of concern for organizational ethics. As part of this broader understanding of what constitutes organizational ethics, I propose that there is a distinction between neonatal ethics, which focuses on the medically oriented patient-based decisions (neonatal ethics as it is now), and NICU ethics, which encompasses the moral issues that arise in the organization and delivery of neonatal care. Within this notion of NICU ethics, I propose that there is a shared duty to ensure that healthcare providers deliver care in a space that is morally habitable. It cannot be considered an acceptable consequence of doing business, that healthcare providers be harmed by changeable organizational practices.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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