Caring for Premature Life and Death: The Relational Dynamics of Detachment in a NICU

ABSTRACT

Drawing on fieldwork in a neonatal intensive care unit (NICU) in Chiang Mai during 2010 and 2012, I examine neonatal care as a contingent entanglement of technological and ethical relationships with vulnerable others. Along the continuum of universal antenatal and delivery care, neonatal medicine becomes a normative part of reproductive health care in Chiang Mai. As the NICU opens its door to sick newborns whose belonging to kinship and the nation-state is uncertain, neonatal care requires deliberate practices to incorporate them into life-sustaining connections. By tracing medical staff’s effort to be accountable to their fragile patients, I show that withdrawing of intensive care is relational work that requires affective involvement and distancing through commensality, prosthetic extensions, and karmic network. This specific mode of care, which is premised on the combination of unconditional openness and careful detachment, offers insight into a possible enactment of hospitality within biomedical institutions.

KEYWORDS:

• Neonatal intensive care unit (NICU)
• end-of-life care
• withdrawing
• ethics
• Thailand

Acknowledgments

I owe a debt of gratitude to Philip Taylor, Kathryn Robinson, Hansjörg Dilger, and Pierre Min for their thoughtful guidance and comments on various versions of this manuscript. I am also grateful to three anonymous reviewers for their insightful suggestions. I am most indebted to Ban Phaet Hospital’s NICU staff and parents for inviting me into their lives.

Funding

Fieldwork was supported by the Australian National University and the Asia Institute of the University of Melbourne.

Notes

1. All names of institutions and people have been changed to ensure anonymity.

2. For the issues related to migrants and uninsured populations’ access to public health care in Thailand, see Seo 2014.

3. Brinchmann and Nortvedt (2001) provided an interesting discussion of how doctors and nurses interpret premature infants’ vulnerability and vitality as a key ethical appeal to care in NICUs.

4. For more discussion on methodological issues of doing ethnographic fieldwork in neonatal intensive care settings, see Vermeulen (2004) and Einarsdóttir (2012).

5. This article focuses on the relationship between the patients and medical staff. A crucial dimension that I do not address is mothers’ experience, in particular of violence and suffering inflicted by anti-abortion laws in Thailand. Under the current punitive approach to abortion, poor women like Suthep’s mother have to give birth to unwanted children because they cannot access safe abortion services and care. For the criminalization of abortion and its moral stigmatization in Thailand, see Whittaker (2004).

6. Based on an ethnographic study in British NICUs, Alderson, Hawthorne, and Killen (2005) emphasized that premature babies are not nonpersons who lack consciousness and the capacity to interact with others but rights-bearing subjects who can actively participate in and influence caring processes.

7. For an overview of Buddhist conceptions of karma, see Keyes and Valentine (1983). In the context of contemporary northern Thailand, Engel and Engel (2010)’s work on personal injuries, Liamputtong and colleagues (2013)’s work on women living with HIV/AIDS, and Cassaniti (2014)’s work on family crisis note the centrality of karma in people’s causal explanations of misfortune and illness.

8. Ploy is an everyday vocabulary conveys intentions and feelings of detachment. Cassaniti (2014) offered an interesting analysis of how such feeling of letting go is mobilized in relation to a broader Buddhist moral metaphysics.

9. One of the local explanations is that the newly born baby’s fontanel, the soft spot on the skull, is not closed yet, so the baby’s spirit can easily go back to the world of spirit, and its body does not need to be cremated.

10. See also Lévinas (1981:91).

11. Anthropologist Brown (2010) showed how fear and respect, a particular kind of relationship based on emotional distance, becomes a key feature of Kenyan health care.

Additional information

Funding

Fieldwork was supported by the Australian National University and the Asia Institute of the University of Melbourne

Notes on contributors

Bo Kyeong Seo

Bo Kyeong Seo is a postdoctoral fellow at Freie Universität Berlin. Her research is primarily on the politics of care and health in Thailand, exploring social suffering, notions of sovereignties, and transnational migration.