Ethical Dimensions of Neonatal Intensive Care: An Organizational Perspective

  • Author / Creator
    Duthie, Katherine M
  • 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.

  • Subjects / Keywords
  • Graduation date
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
    • Department of Public Health Sciences
  • Supervisor / co-supervisor and their department(s)
    • Greiner, Glenn (School of Public Health; Philosophy)
  • Examining committee members and their departments
    • Byrne, Paul (Faculty of Medicine)
    • Shanner, Laura (community member)
    • Austin, Wendy (Faculty of Nursing)
    • Rondeau, Kent (School of Public Health)
    • Mumtaz, Zubia (School of Public Health)
    • Storch, Jan (Faculty of Nursing, UVic)