At the edge of viability: neonatologists' moral experience under uncertainty in Türkiye

Clinical decision-making in periviability, typically between 22 and 25 weeks of gestation, represents one of the most complex intersections of medicine and ethics. Characterised by profound prognostic uncertainty and the absence of clear ethical consensus, this period places neonatologists under significant moral, emotional, and institutional pressure. This study explores how neonatologists in Türkiye experience ethical challenges when making clinical decisions for infants born at the threshold of viability.

A qualitative phenomenological design was employed. Between March 2022 and June 2023, in-depth semi-structured interviews were conducted with 15 neonatologists working in tertiary and quaternary neonatal intensive care units across different regions of Türkiye. Data collection continued until data saturation was reached. All interviews were transcribed and analysed using thematic analysis.

Five interrelated themes were identified that characterise neonatologists' moral experiences in periviable care: moral decision-making under prognostic uncertainty; moral distress in perceived non-beneficial treatment; moral tensions in clinician-parent interactions; legal and institutional constraints on ethical decision-making; and moral loneliness in periviable care. Together, these themes highlight the ethical complexity of caring for infants at the threshold of viability, where uncertainty, responsibility, relational tensions, and structural pressures intersect.

In neonatal intensive care settings in Türkiye, periviable care is experienced as an ethically complex practice shaped by clinical uncertainty and institutional conditions. Strengthening institutional mechanisms for ethical deliberation may help reduce clinicians' experiences of moral loneliness.