title: The use of drugs with a life-shortening effect in end-of-life care in neonates and infants.
abstract: OBJECTIVE
  The purpose was to describe the use of drugs with a possible or certain life-shortening effect in end-of-life care in infants and to evaluate the possibly lethal effect.
  
  
  METHODS
  For 292/298 deaths of live born infants (<1 year), in a 1-year period (between 1 August 1999 and 31 July 2000) in Flanders, Belgium, the attending physician could be identified and was sent an anonymous questionnaire. The questionnaires relating to deaths directly preceded by the administration of drugs were reviewed by a multi-disciplinary panel.
  
  
  RESULTS
  The response rate was 86.6% (253/292). In 57 cases (22.5%), drugs were administered directly before death. In 17/57 cases, the physician explicitly intended to hasten death. In 16/17 cases information about the drug(s) was available: opioids were administered in 14, a muscle relaxant in 5 and potassium chloride in 3 cases. In 13 cases where the lethal effect could be evaluated, the panel judged that the drugs were effective in hastening death in 10 cases. In most cases the estimated life-shortening was <24 h. In 40/57 cases the physician administered drugs to alleviate pain and/or symptoms, taking into account a possible life-shortening effect without explicitly intending it. Opioids were administered in all 30 cases where information about the drug(s) was supplied. In 13 cases the lethal effect could be evaluated, and in 6 cases the panel judged that the drugs had hastened death.
  
  
  CONCLUSIONS
  When life-shortening was explicitly intended, (dosages of) drugs were likely to be lethal. Drugs administered also clearly hastened death in some cases where life-shortening was not explicitly intended.
authors.affiliation: Department of Medical Sociology and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
authors.forename: Veerle
authors.initials: V
authors.lastname: Provoost
authors.forename: Filip
authors.initials: F
authors.lastname: Cools
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: José
authors.initials: J
authors.lastname: Ramet
authors.forename: Peter
authors.initials: P
authors.lastname: Deconinck
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.forename: Anne
authors.initials: A
authors.lastname: Vande Velde
authors.forename: Inge
authors.initials: I
authors.lastname: Van Herreweghe
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000701:Analgesics, Opioid; D001530:Belgium; D003657:Decision Making; D004363:Drug Utilization; D005065:Euthanasia; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033182:Intention; D009125:Muscle Relaxants, Central; D010146:Pain / Q000188:drug therapy; D011189:Potassium Chloride; D010818:Practice Patterns, Physicians'; D013727:Terminal Care / Q000941:ethics
chemical_list: D000701:Analgesics, Opioid; D009125:Muscle Relaxants, Central; D011189:Potassium Chloride