title: The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan.
abstract: The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.
authors.affiliation: School of Nursing, China Medical University, Taichung, Taiwan. lilyflower.nature@gmail.com
authors.forename: Li-Chi
authors.initials: LC
authors.lastname: Huang
authors.forename: Chao-Huei
authors.initials: CH
authors.lastname: Chen
authors.forename: Hsin-Li
authors.initials: HL
authors.lastname: Liu
authors.forename: Ho-Yu
authors.initials: HY
authors.lastname: Lee
authors.forename: Niang-Huei
authors.initials: NH
authors.lastname: Peng
authors.forename: Teh-Ming
authors.initials: TM
authors.lastname: Wang
authors.forename: Yue-Cune
authors.initials: YC
authors.lastname: Chang
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics*; D004502:Education, Medical, Continuing / Q000639:trends; D028741:Ethics Committees, Clinical; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008505:Medical Staff, Hospital / Q000941:ethics*; D008875:Middle Aged; D009359:Neonatology / Q000941:ethics* / Q000639:trends; D009741:Nursing Staff, Hospital / Q000941:ethics*; D012017:Referral and Consultation; D016414:Resuscitation Orders / Q000941:ethics*; D057566:Self Report; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000941:ethics* / Q000379:methods; D028761:Withholding Treatment / Q000941:ethics