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Competing Institutions: Law, Medicine, and Family in Neonatal Intensive Care

Published online by Cambridge University Press:  02 April 2024

Carol A. Heimer
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Abstract

To understand the varying impact of law, we must compare the effects of legal institutions with the effects of rival institutions and the impact one law with the impact of another. We must also ask how the setting in which institutions compete and laws are implemented—very often an organization—shapes outcomes. Using the competition between legal, medical, and familial institutions in infant intensive care units as an example, this article elaborates a theory of institutional competition and therefore of the influence of law in organizations. I show that institutions, including legal institutions, gain influence by working through internal organizational processes. Thus, the impact of law on medical decisionmaking varies with whether legal actors have learned how to be present when decisions are to be made, make legal issues into organizational problems, introduce choice points that require action, and alter the possibility space of eligible solutions. Using variations among the major categories of laws that govern the practice of infant intensive care, the article also shows how organizational and institutional theories help explain why some laws have more impact than others.

Type
Articles
Information
Law & Society Review , Volume 33 , Issue 1 , 1999 , pp. 17 - 66
Copyright
Copyright © 1999 by The Law and Society Association.

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Footnotes

The production of scholarly work is an iterative process, and I hope that John Braithwaite, Wendy Espeland, Richard Lempert, Arthur McEvoy, Lisa Staffen, Arthur Stinchcombe, and several anonymous reviewers will forgive me if their helpful comments are not fully reflected in the final work. I thank Sarah Gatson and Mitchell Stevens for very able research assistance. The American Bar Foundation generously supported the project on which this article is based, and the Law Program in the Research School of the Social Sciences, Australian National University, was a wonderful intellectual home as I revised.

References

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