End-of-life decisions in delivery room and neonatal intensive care unit.
BACKGROUND
The increase in neonatal survival in recent decades has been followed by an increase in later disabilities. This has given rise to many new ethical issues. In different countries, efforts are being made to define ethical guidelines regarding withholding or withdrawing intensive care and end-of-life decisions in critically ill newborn infants. These guidelines have to be differentiated from ethical decision-making models which structure the process of decision making for an individual child. Such a framework has been in existence in our clinic for 10 years.


OBJECTIVE
The aims of this study were to evaluate how end-of-life decisions are taken in our perinatal centre and to analyse whether these decisions are consistent with our framework for structured ethical decision making.


METHODS
199 consecutive neonatal deaths over 5 y were evaluated.


RESULTS
In 157 cases (79%), end-of-life decisions were taken according to our ethical framework; in the remaining 42 cases (21%), the baby died before this could be done. In 92% of cases, parents were involved in the decision and, in all cases but one, agreed with the decision. A patient's life was never intentionally and actively terminated.


CONCLUSIONS
In contrast to earlier years, in-hospital death in our clinic is nowadays usually preceded by structured and documented medical end-of-life decisions.
Arlettaz
Romaine
R
Clinic of Neonatology, University Hospital, Zurich, Switzerland. romaine.arlettaz@usz.ch
Mieth
Dieto
D
Bucher
Hans-Ulrich
HU
Duc
Gabriel
G
Fauchère
Jean-Claude
JC
D003657:Decision Making / Q000941:ethics; D036861:Delivery, Obstetric; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000941:ethics; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D013557:Switzerland; D028761:Withholding Treatment / Q000941:ethics