MEDICAL END-OF-LIFE DECISIONS MADE FOR NEONATES AND INFANTS IN THE NETHERLANDS

Background Advances in neonatal intensive care have lowered the neonat al death rate. There are still some severely ill neonates and infants, however, for whom the application of all possible life-prolonging tre atment modalities may be questioned. Methods We did two studies in the Netherlands. In the first we sent questionnaires to physicians who ha d attended 338 consecutive deaths (August-November, 1995) within the f irst year of life (death-certificate study), and in the second we inte rviewed 31 neonatologists or paediatric intensive-care specialists and 35 general paediatricians. The response rates were 88% and 99%, respe ctively. Findings in the death-certificate study, 57% of all deaths ha d been preceded by a decision to forgo life-sustaining treatment; this decision was accompanied by the administration of potentially life-sh ortening drugs to alleviate pain or other symptoms in 23%, and by the administration of drugs with the explicit aim of hastening death in 8% . A drug was given explicitly to hasten death to neonates not dependen t on life-sustaining treatment in 1% of all death cases. No chance of survival was the main motive in 76% of all end-of-life decisions, and a poor prognosis was the main motive in 18%. The interview study showe d that parents had been involved in making 79% of decisions, The physi cians consulted colleagues about 88% of decisions, Most paediatricians favoured formal review of medical decisions by colleagues together wi th ethical or legal experts. Interpretation Death among neonates and i nfants is commonly preceded by medical end-of-life decisions. Most Dut ch paediatricians seem to find prospects for survival and prognostic f actors relevant in such decisions. Public control by a committee of ph ysicians, paediatricians, ethicists, and legal experts is widely endor sed by paediatricians.