title: To treat or not to treat a newborn child with severe brain damage? A cross-sectional study of physicians' and the general population's perceptions of intentions.
abstract: Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50-62)] and the general population [53 % (CI 49-58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient's symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life.
authors.affiliation: Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Rydvall
authors.forename: Niklas
authors.initials: N
authors.lastname: Juth
authors.forename: Mikael
authors.initials: M
authors.lastname: Sandlund
authors.forename: Magnus
authors.initials: M
authors.lastname: Domellöf
authors.forename: Niels
authors.initials: N
authors.lastname: Lynøe
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001927:Brain Diseases / Q000628:therapy*; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D026689:Ethical Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D033182:Intention; D008297:Male; D008875:Middle Aged; D009014:Morals; D010465:Perception; D010686:Philosophy, Medical; D010820:Physicians / Q000523:psychology*; D012121:Respiration, Artificial; D013548:Sweden; D028761:Withholding Treatment / Q000941:ethics*