title: Medical end-of-life decisions made for neonates and infants in the Netherlands.
abstract: 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.
  
  
  RESULTS
  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. Most paediatricians favoured formal review of medical decisions by colleagues together with ethical or legal experts.
  
  
  CONCLUSIONS
  Death among neonates and infants is commonly preceded by medical end-of-life decisions. Most Dutch paediatricians seem to find prospects for survival and prognostic factors relevant in such decisions. Public control by a committee of physicians, paediatricians, ethicists, and legal experts is widely endorsed by paediatricians.
authors.affiliation: Department of Public Health, Erasmus University Rotterdam, Netherlands. vanderheide@mgz.fgg.eur.nl
authors.forename: A
authors.initials: A
authors.lastname: van der Heide
authors.forename: P J
authors.initials: PJ
authors.lastname: van der Maas
authors.forename: G
authors.initials: G
authors.lastname: van der Wal
authors.forename: C L
authors.initials: CL
authors.lastname: de Graaff
authors.forename: J G
authors.initials: JG
authors.lastname: Kester
authors.forename: L A
authors.initials: LA
authors.lastname: Kollée
authors.forename: R
authors.initials: R
authors.lastname: de Leeuw
authors.forename: R A
authors.initials: RA
authors.lastname: Holl
mesh_terms: D001291:Attitude of Health Personnel; D003644:Death Certificates; D003657:Decision Making; D005065:Euthanasia / Q000523:psychology / Q000706:statistics & numerical data; D028601:Euthanasia, Active; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008511:Medicine; D009426:Netherlands; D011379:Prognosis; D012926:Social Control, Formal; D013038:Specialization; D011795:Surveys and Questionnaires; D028761:Withholding Treatment