Using potentially life-shortening drugs in neonates and infants

Objective: To describe the frequency, background, and impact of decisions t o give analgesic or other drugs that may, intentionally or unintentionally, shorten the life-span of severely ill neonates. Setting: The Netherlands. Design: Retrospective, cross-sectional study. Patients: Questionnaires were mailed in The Netherlands to physicians repor ting 338 consecutive deaths of infants under 1 yr of age from August throug h November 1995. Interventions: None. Measurements and Main Results. Questions were as)ted about medical end-of-l ife decisions preceding the death of the infant and about the decision-maki ng process. Potentially life-shortening drugs, mostly opioids, were given i n 37% of all deaths. The estimated effect in terms of the shortening of lif e was <1 wk in 72% of all patients in whom the administration of potentiall y life-shortening drugs had been the most important end-of-lifo decision. M ost decisions to administer such drugs were dis-cussed with parents and col leagues. The decisions were discussed regarding virtually all patients in w hom the physician had intended to hasten death; doses of opioids tended to be larger in this group. Conclusions: The frequency with which drugs that may shorten life are admin istered before the death of severely ill infants confirms the important rol e of modern medicine in dying in neonatology. Most physicians caring for ne onates feel that palliative medication may be warranted in dying infants, e ven if it shortens life. A distinction between intentionally ending life an d providing adequate terminal care by alleviating pain or other symptoms, w hich is important in moral and judicial terms, is probably not easily made for some of these patients.