Technical, Medical, and Organizational Innovations in Neonatal Intensive Care in French Public Hospitals and the Transformation of Ethical Decision-Making

This chapter uses participatory research to analyze the impact of medical and organizational innovations on ethical decision-making in a neonatal intensive care unit at a French public hospital (Centre Hospitalier du Mans). These decisions, defined as “ethical” in the work organization processes, concern decisions to limit, stop, or continue active therapies, as well as particularly risky decisive stages (e.g., catheter insertion). Taking into account the child’s rhythms and modes of functioning, the multidisciplinary approach and new articulations between care and medical logics have had a major impact on the reconfiguration of ethical decision-making processes. This chapter focuses on the scope and limits of such approaches, showing how, in some cases, this innovation has led to profound changes in decision-making issues and, ultimately, in the results of decision-making.