title: End-of-life decision making in neonates and infants: comparison of The Netherlands and Belgium (Flanders).
abstract: OBJECTIVE
  We compared the results of two recent studies on end-of-life decisions (ELDs) for neonates and infants in Belgium (Flanders) and The Netherlands.
  
  
  METHODS
  Questionnaires were sent to physicians who reported the death of a child under the age of 1 (Belgium: n = 292, response 87%; Netherlands: n = 249, response 84%). The questionnaires included structured questions about whether death had been preceded by ELDs, and about the decision-making process.
  
  
  RESULTS
  In both countries, in about 25% of all deaths a life-sustaining treatment was withheld, and in about 40% pain or other symptoms were alleviated taking into account that death might be hastened. In Belgium, a life-sustaining treatment was less often withdrawn than in The Netherlands (32% vs. 50%, respectively). Drugs were administered with the explicit intention of hastening death in similar percentages of all deaths (Belgium: 7%; Netherlands: 9%). Dutch physicians more often than Belgian physicians discussed ELDs with parents (96% vs. 81%, respectively), and with colleague physicians (94% vs. 80%, respectively).
  
  
  CONCLUSIONS
  End-of-life decision making in severely ill neonates seems to be rather similar in Belgium and The Netherlands. Differences are that Dutch physicians more often withdraw life-sustaining treatment. Furthermore, parents and colleague physicians are more often involved in the decision making in The Netherlands.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. a.vrakking@erasmusmc.nl
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Vrakking
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Veerle
authors.initials: V
authors.lastname: Provoost
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D001530:Belgium; D003657:Decision Making; D028601:Euthanasia, Active / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009426:Netherlands; D010290:Parents / Q000523:psychology*; D011795:Surveys and Questionnaires; D028761:Withholding Treatment