Medical end-of-life decisions in neonates and infants in Flanders.
BACKGROUND
Paediatricians are increasingly confronted with end-of-life decisions in critically ill neonates and infants. Little is known about the frequency and characteristics of end-of-life decisions in this population, nor about the relation with clinical and patients' characteristics.


METHODS
A death-certificate study was done for all deaths of neonates and infants in the whole of Flanders over a 12 month period (August, 1999, to July, 2000). We sent an anonymous questionnaire by mail to the attending physician for each of the 292 children who died under the age of 1 year. Information on patients was obtained from national registers. An attitude study was done for all physicians who attended at least one death during the study period.


RESULTS
253 (87%) of the 292 questionnaires were returned, and 121 (69%) of the 175 physicians involved completed the attitude questions. An end-of-life decision was possible in 194 (77%; 95% CI 70.4-82.4) of the 253 deaths studied, and such a decision was made in 143 cases (57%; 48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13%vs 3%; p=0.018). The attitude study showed that 95 (79%; 70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%; 48.1-66.5) of 120 supported legalisation of life termination in some cases.


CONCLUSIONS
Death of neonates and infants is commonly preceded by an end-of-life decision. The type of decision varied substantially according to the age of the child. Most physicians favour legalisation of the use of lethal drugs in some cases.
Provoost
Veerle
V
Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium.
Cools
Filip
F
Mortier
Freddy
F
Bilsen
Johan
J
Ramet
José
J
Vandenplas
Yvan
Y
Deliens
Luc
L
D001291:Attitude of Health Personnel; D001530:Belgium; D003657:Decision Making; D028601:Euthanasia, Active / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059408:Pain Management; D010166:Palliative Care / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000706:statistics & numerical data