The use of drugs with a life-shortening effect in end-of-life care in neonates and infants.
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.
Provoost
Veerle
V
Department of Medical Sociology and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
Cools
Filip
F
Bilsen
Johan
J
Ramet
José
J
Deconinck
Peter
P
Vander Stichele
Robert
R
Vande Velde
Anne
A
Van Herreweghe
Inge
I
Mortier
Freddy
F
Vandenplas
Yvan
Y
Deliens
Luc
L
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
D000701:Analgesics, Opioid; D009125:Muscle Relaxants, Central; D011189:Potassium Chloride