End-of-life decisions for children under 1 year of age in the Netherlands: decreased frequency of administration of drugs to deliberately hasten death.
OBJECTIVE
To assess whether the frequency of end-of-life decisions for children under 1 year of age in the Netherlands has changed since ultrasound examination around 20 weeks of gestation became routine in 2007 and after a legal provision for deliberately ending the life of a newborn was set up that same year.


METHODS
This was a recurrent nationwide cross-sectional study in the Netherlands. In 2010, a sample of death certificates from children under 1 year of age was derived from the central death registry. All 223 deaths that occurred in a 4-month study period were included. Physicians who had reported a non-sudden death (n=206) were sent a questionnaire on the end-of-life decisions made. 160 questionnaires were returned (response 78%).


RESULTS
In 2010, 63% of all deaths of children under 1 year of age were preceded by an end-of-life decision-a percentage comparable to other times when this study was conducted (1995, 2001, 2005). These end-of-life decisions were mainly decisions to withdraw or withhold potentially life-sustaining treatment. In 2010, the percentage of cases in which drugs were administered with the explicit intention to hasten death was 1%, while in 1995 and 2001, this was 9% and in 2005, this was 8%.


CONCLUSIONS
There has been a reduction of infant deaths that followed administration of drugs with the explicit intention to hasten death. One explanation for this reduction relates to the introduction of routine ultrasound examination around 20 weeks of gestation. In addition, the introduction of legal criteria and a review process for deliberately ending the life of a newborn may have left Dutch physicians with less room to hasten death.
Department of General Practice, Section Medical Ethics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands.
Katja
K
ten Cate
Department of General Practice, Section Medical Ethics, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands Department of Medical Ethics and Philosophy, Erasmus Medical Centre/Erasmus University Rotterdam, Rotterdam, The Netherlands.
Suzanne
S
van de Vathorst
Department of Public and Occupational Health, EMGO Institute, VU Medical Centre/VU University Amsterdam, Amsterdam, The Netherlands.
Bregje D
BD
Onwuteaka-Philipsen
Department of Public Health, Erasmus Medical Centre/Erasmus University Rotterdam, Rotterdam, The Netherlands.
Agnes
A
van der Heide
D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000941:ethics; D003430:Cross-Sectional Studies; D003644:Death Certificates; D005065:Euthanasia / Q000941:ethics / Q000706:statistics & numerical data*; D028601:Euthanasia, Active / Q000706:statistics & numerical data; D005066:Euthanasia, Passive / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012042:Registries; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal; D028761:Withholding Treatment / Q000706:statistics & numerical data*
Decision-making; End-of-life; Law; Neonatology