End-of-life decisions in neonates.
In a large percentage of the infants who die in the neonatal intensive care setting, an end-of-life decision was made before death, usually a decision to forego life-sustaining treatment. This was confirmed in a recent study in The Netherlands that showed also that a minority of cases include the administration of drugs to hasten death, usually in patients with severe congenital multiple or central nervous system anomalies. Over 80% of Dutch pediatricians support this option under certain conditions. Almost all pediatricians are of the opinion that these cases have to be subject to public review, but they favor review by a committee of independent medical, judicial, and ethical professionals rather than by the public prosecutor. A discussion group on this subject recently made a proposal for such a reviewing procedure to the Dutch governmental authorities and described the requirements concerning end-of-life decisions in neonatal medicine. Proper handling of ethical aspects of medical treatment including review and feedback after end-of-life decisions can contribute to high standards of quality of care.
Kollée
L A
LA
Department of Neonatology, University Hospital of Nijmegen, The Netherlands.
van der Heide
A
A
de Leeuw
R
R
van der Maas
P J
PJ
van der Wal
G
G
D000015:Abnormalities, Multiple; D001291:Attitude of Health Personnel; D002490:Central Nervous System / Q000002:abnormalities; D005065:Euthanasia; D005066:Euthanasia, Passive; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D009359:Neonatology