Medical end-of-life decisions made for neonates and infants in the Netherlands.
Background Advances in neonatal intensive care have lowered the neonatal death rate.
There are still some severely ill neonates and infants, however, for whom the application of all possible life-prolonging treatment modalities may be questioned.
Methods We did two studies in the Netherlands.
In the first we sent questionnaires to physicians who had attended 338 consecutive deaths (August-November, 1995) within the first year of life (death-certificate study), and in the second we interviewed 31 neonatologists or paediatric intensive-care specialists and 35 general paediatricians.
The response rates were 88% and 99%, respectively.
Findings In the death-certificate study, 57% of all deaths had been preceded by a decision to forgo life-sustaining treatment ; this decision was accompanied by the administration of potentially life-shortening drugs to alleviate pain or other symptoms in 23%, and by the administration of drugs with the explicit aim of hastening death in 8%. A drug was given explicitly to hasten death to neonates not dependent on life-sustaining treatment in 1% of all death cases.
No chance of survival was the main motive in 76% of all end-of-life decisions, and a poor prognosis was the main motive in 18%. The interview study showed that parents had been involved in making 79% of decisions.
The physicians consulted colleagues about 88% of decisions. (...)
Mots-clés Pascal : Néonatal, Enfant, Homme, Critère décision, Arrêt définitif, Vie physiologique, Etiologie, Aspect médicolégal, Responsabilité professionnelle, Pays Bas, Europe, Pronostic, Soin intensif, Pédiatrie, Réanimation, Organisation santé, Ethique
Mots-clés Pascal anglais : Neonatal, Child, Human, Decision criterion, Definitive shutdown, Life (physiology), Etiology, Forensic aspect, Occupational responsibility, Netherlands, Europe, Prognosis, Intensive care, Pediatrics, Resuscitation, Public health organization, Ethics
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0397069
Code Inist : 002B27C. Création : 12/09/1997.