title: Forgoing life-sustaining treatments in children: a comparison between Northern and Southern European pediatric intensive care units.
abstract: OBJECTIVE
  This study was conducted to determine how the decision-making process to forgo life support differs between southern and northern European pediatric intensive care units.
  
  
  METHODS
  Multiple-center, prospective study.
  
  
  METHODS
  Thirty-nine pediatric intensive care units: 12 from northern Europe and 27 from southern Europe.
  
  
  METHODS
  All consecutive deaths were recorded over a 4-month period. Group 1 and group 2 included patients who died in northern and southern pediatric intensive care units, respectively.
  
  
  METHODS
  None.
  
  
  RESULTS
  Three hundred fifty children were enrolled, 68 in group 1 and 282 in group 2. The decision to forgo life-sustaining treatment was made in 116 children (group 1, n = 32; group 2, n = 84). In both groups, the decision was discussed by caregivers during a formal meeting. The decision to forgo life-sustaining treatment was more often made in northern countries than in southern ones (47% vs. 30%, p =.02). Parents were informed of this decision in 95% of cases in group 1 vs. 68% in group 2 (p =.01). In both groups, the final decision was made by the medical staff. Parents' contributions to the decision-making process did not differ between the two groups according to the practitioners' opinion. The decision was documented in the medical charts in 100% of the cases in group 1 and in 51% of the cases in group 2 (p =.0001).
  
  
  CONCLUSIONS
  The decision-making process appears to be similar between northern and southern European countries. The respective contributions of the parents and the medical staff in the final decision itself seem to be identical between northern and southern countries. However, in northern European countries, the level of parents' information about the decision-making process appears higher and the decision is more often documented in the medical chart.
authors.affiliation: Service de Réanimation Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Bicêtre, France. denis.devictor@bct.ap-hop-paris.fr.
authors.forename: Denis J
authors.initials: DJ
authors.lastname: Devictor
authors.forename: Duc Tinh
authors.initials: DT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003659:Decision Making, Organizational; D005060:Europe; D005066:Euthanasia, Passive / Q000523:psychology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010290:Parents / Q000523:psychology; D010358:Patient Participation; D011446:Prospective Studies