Infants’ Best Interests in End-of-life Care for Newborns

Willems, Dick L.; Verhagen, Eduard; Wijlick, Eric van

doi:10.1542/peds.2014-0780

Cited by 50 publications

(29 citation statements)

References 23 publications

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“…In other words, the respondents agreed more with using conservative, rather than active, interventions in relation to end-of-life decision making about dying neonates; these results are similar to the findings obtained from studies conducted in other Asian countries 9,11) . In contrast, our results differ from those obtained from studies conducted in European countries, where many doctors agreed with using active interventions, such as withdrawal of mechanical ventilation 8,[12][13][14][15] . Interestingly, the respondents agreed most with active interventions required for reducing pain (80%); this differs from findings of other studies conducted in Asian countries but is similar to the high agreement rate observed in European studies 4,8,15) .…”

Section: Discussioncontrasting

confidence: 99%

Investigation of Neonatal Staff Members' Attitudes toward End-of-Life Decision Making about Dying Newborns

et al. 2017

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Purpose: The objective of this study was to investigate physicians' attitudes toward ethical end-of-life decision making about dying newborns. Methods: Between October and December 2015, we surveyed 185 neonatal staff members working at 6 neonatal intensive care units to investigate their attitudes toward ethical end-of-life decision making about dying newborns. Results:The respondents generally agreed with using sedatives/analgesics to suppress pain despite the risk of fatality (80%), continuing current treatment without using other treatment methods (56.2%), and withholding emergency treatment in the form of cardiac arrest resuscitation (48.1%). In contrast, most respondents disagre ed with administering drugs for the purpose of ending life, withholding neonatal intensive care, and withholding mechanical ventilation. Although the respondents believed that it is necessary to suggest that the parents of dying neonates sign do-notresuscitate (DNR) orders (62.7%), most of them found it difficult to talk to parents/ families about DNR orders (90.8%), or wanted to refrain from obtaining families' consent in person (84.9%). Conclusion: Korean neonatal staff members believed that withholding or withdrawal of treatment is necessary when making ethical decisions about dying neonates; however, they preferred to use conservative, rather than active interventions.

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Section: Discussioncontrasting

confidence: 99%

Investigation of Neonatal Staff Members' Attitudes toward End-of-Life Decision Making about Dying Newborns

et al. 2017

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“…According to the expert committee's definition of deliberately ending life, this act would classify as such and should be reported 3. The KNMG also states this act should be reported as deliberately ending life, but they disagree with the expert committee about how it should be reviewed 12. The physician in case 1, however, classified this death as a ‘natural’ death and did not report it to the committee.…”

Section: Discussionmentioning

confidence: 99%

“…Life-shortening drugs to hasten death might then be used to end a protracted dying process 10 11. Recently, the Royal Dutch Medical Association (KNMG) has published a report with recommendations on end-of-life decisions for newborns, in which they express the opinion that the use of lethal drugs (ie, neuromuscular blockers) to end a protracted dying process (whether to relieve the suffering of the patient or the parents) should be seen as acceptable 12. According to the KNMG, this act should be reported to the expert committee who should review it as acceptable.…”

Section: Discussionmentioning

confidence: 99%

End-of-life decisions for children under 1 year of age in the Netherlands: decreased frequency of administration of drugs to deliberately hasten death

2015

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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.

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“…25 A study in the Netherlands suggested that treatment should generally be considered conditional and if the treatment fails, it can be abandoned. 26 It is noted that for all healthcare providers who have the decisive role in end of life decisions, euthanasia and decision making on the provision of care can create serious ethical problems 27 that needs to be discussed with more details in future studies.…”

Section: Disscusionmentioning

confidence: 99%

Physicians and nurses’ perspectives of encountering neonates with poor prognosis

Rafiee

Rabiei

Rafati³

et al. 2020

Preprint

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Introduction: Decision making regarding the treatment of neonates with poor prognoses is difficult for healthcare staff working in the neonatal intensive care unit (NICU). This study aimed to investigate the attitude of physicians and nurses towards the value of life and ethical decision making when encountering neonates with poor prognosis in the NICU. Methods: A cross-sectional study was conducted in 2016. This study was carried out in five NICUs of five hospitals in Tehran city, Iran. The perspectives of 144 paediatricians, gynaecologist and nurses were assessed using the questionnaire of attitude toward the value of life and agreement on intensive care management on three hypothetical cases scenarios of neonates with poor prognosis. Data was analysed using descriptive and inferential statistics. Results: The negative agreement on the no initiation of intensive care measures and the discontinuation of resuscitation in neonates with poor prognosis was more than the positive agreement. Also, various factors influenced the participants’ decision making for the provision of care to neonates. Regarding the case scenarios, the participants agreed on the provision of aggressive, conservative, and palliative care with various frequencies. This study confirms the importance of healthcare providers’ perspectives and their impacts on ethical decision making. The participants in this study favoured the value or sacredness of life and agreed on the use of all therapeutic measures for neonates with poor prognosis. Conclusion: More studies are required to improve our understandings of factors influencing ethical decision makings by healthcare providers when encountering neonates with poor prognosis in NICUs. Key words: Decision making, ethics, neonatal intensive care unit, poor prognosis, value of life

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Infants’ Best Interests in End-of-life Care for Newborns

Cited by 50 publications

References 23 publications

Investigation of Neonatal Staff Members' Attitudes toward End-of-Life Decision Making about Dying Newborns

Investigation of Neonatal Staff Members' Attitudes toward End-of-Life Decision Making about Dying Newborns

End-of-life decisions for children under 1 year of age in the Netherlands: decreased frequency of administration of drugs to deliberately hasten death

Physicians and nurses’ perspectives of encountering neonates with poor prognosis

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