National ethical directives and practical aspects of forgoing life-sustaining treatment in newborn infants in a Swiss intensive care unit.
OBJECTIVE
How do actual aspects of forgoing life supporting therapy (LST) in newborn infants compare with national ethical directives in a Swiss intensive care unit?


METHODS
A prospective set of data on deaths after forgoing LST over a three year period in a single intensive care unit is analysed in view of the directives issued by the Swiss Academy for Medical Sciences (SAMS).


RESULTS
Thirty-four newborn infants died after a decision to forgo LST, 21 after withdrawing and 13 after withholding. The decision making process was confined to the caregivers' team. Parents rarely initiated the discussion but participated in all decisions and were considered as willing in 32% and consenting in 68%. Futility was invoked in 79% of cases and poor developmental outcome in 21%. Respiratory support was forgone in 59%, circulatory support in 6% and both in 35%. The mother assisted the child at the time of death in 91%. At that time, 82% of infants were receiving opiates and 18% benzodiazepines, some in a higher than usual dose. Death occurred at a median of 13 (25-75% = 6-25) minutes after withdrawing LST and 70 (27.5-147.5) after withholding (p <0.001) without correlation with the dose of analgesic or sedative administered. None of these observations obviously departed from the Swiss ethical directives.


CONCLUSIONS
Practices surrounding forgoing LST in newborn infants in a Swiss intensive care unit match ethical directives. Factors leading to occasional use of unusually high dose of analgesic and sedative drugs remain to be identified.
Berner
Michel E
ME
Department of Paediatrics, Service of Neonatology and Paediatric Intensive Care, University Hospital, Geneva, Switzerland. michel.berner@hcuge.ch
Rimensberger
Peter C
PC
Hüppi
Petra S
PS
Pfister
Riccardo E
RE
D003657:Decision Making / Q000941:ethics; D026690:Ethics, Clinical; D028601:Euthanasia, Active; D005865:Gestational Age; D019983:Guideline Adherence; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000941:ethics*; D008020:Life Support Care / Q000941:ethics*; D018447:Medical Futility; D013557:Switzerland; D028761:Withholding Treatment / Q000941:ethics*