Abstract
The manner in which the contextual dynamics of the neonatal intensive care unit (NICU) culture influence decisions around withholding and withdrawing treatment for very low birth weight infants is examined based on sociological studies of the NICU culture. The influence of these dynamics on nurse and parent participation in treatment decisions is discussed. Steps toward increasing nurses' role in decision making and ability to empower the participation of parents include (a) using an understanding of the dynamics of the individual NICU to establish a collaborative team culture, and (b) demonstrating that data obtained through relationship with the infant make an important and valid contribution to ethical decision making.