immediate treatment? What should be done in the even harder cases, when babies are off support
and are breathing independently but their life does not seem to be worth living? Should fluids be
withheld? The book ignores crucial decades-long debates in UK and US neonatal ethics and law,
about ‘withholding futile treatment’ and ‘double effect’. The UK and US would reject the Dutch
concepts, ‘life-ending action’, ‘senseless life’ and the oxymoron ‘unliveable life’. Mesman aims to
describe how morality is performed, but ‘morality’ appears to be so relative, situated, undefined,
lacking in agreed principles, and cited to support any pragmatic course, that it is unclear how morals
differ from maths, utility or any other kind of calculation.
Medical and nursing perspectives predominate. Those of the other main actors, parents and babies,
are largely excluded. Their suffering is briefly described, but their humanity is missing from central
analyses, so that immensely complex neonatal dilemmas risk being reduced into mechanical ones.
Types of time are only described from the staff point of view. Conflicts between neonatal clock
time and the babies’ and mothers’ biological rhythms and health care needs are ignored. Mesman
(mis)asserts that babies’ prognoses equate with their identity, and that the baby, referred to as ‘it’, is
lost and forgotten inside the tangle of technology. It is disappointing that the real transforming
neonatal innovations, based on Heidelisa Als’s practical work with babies as persons, agents and
self health carers, is ignored. We used Als’s work to show how neonatal care continually involves
working with babies to wean them off dependence on the technology and intensive nursing,
whereas Mesman sees fixed medically prescribed systems instead of dynamic interactive ones.
Mesman sets up supposed dichotomies: experience versus expectation; medical expertise in the
particular child or in the statistical group; the question either ‘how is the child?’ or ‘what shall we
do?’ However, each pair is inseparable and constantly interacting. Other integral key topics,
including the place of moral emotions, and tensions between lab and nursery where families have
their most intimate private experiences scrutinised in the public arena, are ignored, which
diminishes understanding of neonatal uncertainties and pioneering.
I doubt that practitioners would gain much from reading this book, and expect the main readers
will be ethnographic researchers and healthcare lecturers and students. I hope they will debate the
author’s views rather than endorse them.
Priscilla Alderson Institute of Education University of London