Conflicts about end-of-life decisions in NICUs in the Netherlands.
OBJECTIVE
To determine the frequency and background of conflicts about neonatal end-of-life (EoL) decisions.


METHODS
We reviewed the medical files of 359 newborns who had died during 1 year in the 10 Dutch NICUs and identified 150 deaths that were preceded by an EoL decision on the basis of the child's poor prognosis. The attending neonatologists of 147 of the 150 newborns were interviewed to obtain details about the decision-making process.


RESULTS
EoL decisions about infants with a poor prognosis were initiated mainly by the physician, who subsequently involved the parents. Conflicts between parents and the medical team occurred in 18 of 147 cases and were mostly about the child's poor neurologic prognosis. Conflicts within the team occurred in 6 of 147 cases and concerned the uncertainty of the prognosis. In the event of conflict, the EoL decision was postponed. Consensus was reached by calling additional meetings, performing additional diagnostic tests, or obtaining a second opinion. The chief causes of conflict encountered by the physicians were religious convictions that forbade withdrawal of life-sustaining treatment and poor communication between the parents and the team.


CONCLUSIONS
The parents were involved in all EoL decision-making processes, and consensus was ultimately reached in all cases. Conflicts within the team occurred in 4% of the cases and between the team and the parents in 12% of the cases. The conflicts were resolved by postponing the EoL decision until consensus was achieved.
Verhagen
A A Eduard
AA
Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands. e.verhagen@bkk.umcg.nl
de Vos
Mirjam
M
Dorscheidt
Jozef H H M
JH
Engels
Bernadette
B
Hubben
Joep H
JH
Sauer
Pieter J
PJ
D003657:Decision Making; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009426:Netherlands; D010348:Patient Care Team; D011379:Prognosis; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000706:statistics & numerical data*