Background <p>Delivering bad news in the Neonatal Intensive Care Unit (NICU) constitutes a profound ethical and emotional challenge. In China, this complexity is intensified by a defensive medical culture and strained physician-family dynamics. This study explores the lived experiences of Chinese neonatologists navigating these high-stakes interactions to uncover the phenomenon’s essential structure.</p> Methods <p>A descriptive phenomenological study was conducted. Using a purposive sampling strategy, 19 neonatologists from a tertiary NICU in Western China were recruited. Data were collected through individual face-to-face, semi-structured in-depth interviews and analyzed using Colaizzi’s seven-step method, with rigorous adherence to the COREQ guidelines to ensure trustworthiness.</p> Results <p>Five interconnected themes emerged: (1) The defensive paradox—strategic communication in a low-trust arena; (2) “Pushing the child off the cliff”—the burden of proxy decision-making; (3) Embodied moral distress—the somatic and emotional toll; (4) From technical anxiety to phronesis—identity reconstruction through virtue ethics; and (5) Systemic solitude—structural deficits and the training-practice gap. The findings reveal a trajectory from defensive adaptation and the moral burden of proxy agency to embodied suffering, mitigated by indigenous cultural meaning-making (<i>xiuxing</i>), yet constrained by systemic solitude.</p> Conclusions <p>Delivering bad news in the Chinese context transcends information transmission, representing a form of moral practice that leaves indelible somatic marks on physicians. While practitioners cultivate individual resilience through professional wisdom and spiritual reframing, this “weight” is compounded by institutional voids. Addressing these challenges requires shifting from individual adaptation to multilevel systemic support, including culturally-adapted training, organizational support structures, and clinical ethics consultation services.</p>