Neonatal Bioethics examines the everyday challenges and issues, which doctors and families face when a child is in the neonatal intensive care unit. Written by two doctors, John Lantos a pediatrician, and William Meadow, a pediatrician and neonatologist, both draw on their vast base of experience and knowledge to present a book, which examines neonatology and the NICU from its inception in the late 1950s to its current status in hospitals half a century later. Landmark cases and personal experiences are used to illustrate the moral dilemmas that doctors have faced in one of the most controversial areas of medicine.

            The book is separated into three eras to show how neonatology has developed and grown more complex through the years. The rise of technology and medical advancements are the focuses of era one. With the emergence of the Baby Doe case, era two looks at questions of medical futility and informed consent within the NICU. Finally, the third era explores how a standardized set of decision making procedures was instituted.

            Part one of the book begins by looking at the development of medical technology, which shaped the need for a NICU. It stresses that there was not one specific technique or discovery that created neonatology. Rather it was a series of steps, findings, and advancements, which were reworked, revised or abandoned to create a current medical practice. This system is still not perfect but has drastically improved. One of the main points to take from these early days of research was that there was no informed consent of the parents, and no rhyme or reason as to which babies were treated. It was not until the 1970s that that doctors and parents began making these difficult treatment decisions together.

            The second era began in 1982 when the Baby Doe case became a national controversy. It brought to light the fact that doctors and parents do not always agree on proper treatment or what is in the best interest for the newborn. This case gave way to a period time in which a number of federal regulations would be placed on NICUs and doctors throughout the country. These regulations would be overturned and revised leaving all parties, which were involved, confused as to what is considered medical futility and the specific rights of newborns. As NICUs grew and expanded in the 1990s becoming a multimillion dollar sector of health care, the practice of informed consent became an issue. Further complicating this issue was the emergence of court cases all over the country. In these cases parents claimed that they would have made different treatment decisions had they been given informed consent about procedures being done to their child.

 The third era looks at the present state of the NICU, where there has been melding between clinical and legal paradigms. There is now a widespread consensus on how decisions are to be made. To withhold or withdraw treatment is permissible when the likelihood for survival is low, or when the treatment will result in severe neurological or physical impairments. Otherwise treatment is morally obligated. There should be a shared decision in which the physician guides the parents towards a decision that is authentic and genuine for them.

            The book concludes that when making decisions in neonatology, there is compromise; no one moral view prevails over another. It is necessary to try to include the values of all of those who have are vested in) in the outcome of the child. This showed that the paradigm of neonatology is a success story among modern medicine, because  now each baby has a moral worth and corresponding moral rights that need to be respected. 

            Overall, this book is an insightful and interesting look into the world of neonatology. It offers a balanced view of the decision making process of all parties involved. It is a must-read    for anyone  in neonatology or related fields, as well as for those who work with neurologically or physically impaired children. This book can also be recommended for parents who are expecting, so  they can fully consider all their options and try to find their moral stance on treatment versus non-treatment should a need for a visit to the NICU ever arise.