End-of-life decision making in neonates and infants: comparison of The Netherlands and Belgium (Flanders).
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 In Belgium, a life-sustaining treatment was less often withdrawn than in The Netherlands (32% vs. 50%, respectively).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.
Vrakking
Astrid M
AM
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. a.vrakking@erasmusmc.nl
van der Heide
Agnes
A
Provoost
Veerle
V
Bilsen
Johan
J
van der Wal
Gerrit
G
Deliens
Luc
L
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