End-of-life choices for African-American and white infants in a neonatal intensive-care unit: a pilot study.
BACKGROUND
African-American adults are more likely than white adults to desire the continuation of life-sustaining medical treatment (LSMT) at the end of life. No studies have examined racial differences in parental end-of-life decisions for neonates.


OBJECTIVE
To collect preliminary data to determine whether differences exist in the choices made by parents of African-American and white infants when a physician has recommended withholding or withdrawing LSMT from their infant to develop hypotheses for future work.


METHODS
A retrospective chart review of African-American and white infants who died in an urban neonatal intensive care unit (NICU) over a two-year period. Charts were abstracted for demographics, cause of death, and documentation of meetings where the physician recommended withholding or withdrawing LSMT.


RESULTS
Thirty-eight infant charts met study criteria (58% African-American, 42% white). Documentation of physician recommendations to limit LSMT was present in 61% of charts. Approached families of white infants agreed to limit LSMT 80% of the time compared to 62% of the families of African-American infants.


CONCLUSIONS
In this pilot study, parents of African-American and white infants appeared to make different end-of-life choices for their children. A larger study is needed to confirm these findings and further explore contributing factors such as mistrust, religiosity, and perceived discrimination.
Moseley
Kathryn L
KL
Child Health Evaluation and Research Unit (CHEAR), Division of General Pediatrics, University of Michigan Medical School, 6C13 NIB, Box 0456300 N. Ingalls St., Ann Arbor, MI 48109-0456, USA. klmosele@med.umich.edu
Church
Annamaria
A
Hempel
Bridget
B
Yuan
Harry
H
Goold
Susan Door
SD
Freed
Gary L
GL
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D001294:Attitude to Health / Q000208:ethnology*; D016638:Critical Illness / Q000523:psychology / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008020:Life Support Care / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D044465:White People / Q000523:psychology*; D028761:Withholding Treatment