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.