May the real surrogate stand up: a pluralist critique of the shared decision-making model in neonatal intensive care
Bibliographic record
Abstract
Abstract May the Real Surrogate Stand-Up: A Pluralist Critique of the Shared Decision-Making Model in Neonatal Intensive Care In the fast-paced environment of the neonatal intensive care unit (NICU), decisions about the health care of newborns involve multiple - and sometimes competing - normative forces. Informed by critical legal pluralism, this thesis offers an analysis of the normative interactions that emerge when parents and health care professionals meet at the bedside of a critically ill newborn. Using the shared decision-making model favored by the Canadian Paediatric Society (CPS) in its 2004 position statement on treatment decisions regarding infant, children and adolescents, I claim that in the NICU context consent is not sought in cases of medical certainty, where the best interest of the patient has already been ascertained according to medical norms. Consequently, the "shared" component of decision-making occurs only after the cause for decision-making has been determined by the child's health care team and presented to the child's surrogate decision-makers. Using ethnographic studies on the lived experience of parents in NICU, I question the marked difference between the authority given to parents by Canadian legal and medical guidelines and the authority they are allowed to exercise in fact at their child's bedside. I conclude by a critical reflection on the emergence of plural law in the NICU trough dynamics of parental resistance or conformity to accepted medical norms.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.050 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.016 | 0.139 |
| Scholarly communication | 0.018 | 0.013 |
| Open science | 0.004 | 0.010 |
| Research integrity | 0.013 | 0.021 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".