Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Abstract

Objective To investigate Belgian pediatric intensive care nurses' involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect. Methods Questionnaires were distributed to 141 nurses working in 5 of the 7 pediatric intensive care units in Belgium. Nurses were asked to recall the last child in their care whose treatment involved an end-of-life decision and to describe anonymously their involvement in the decision. Attitudes were ascertained by means of statements and a Likert scale. Results Questionnaires were completed by 89 nurses (63%). During the preceding 2 years, 76 (85%) had cared for at least 1 child for whom a medical end-of-life decision had been made. Nurses were involved in initiating the decision in 17% of cases, participated in decision making in 50%, and played a role in carrying out the decision in 90%. Only 6% of nurses found it always ethically wrong to hasten the death of a child by administering lethal drugs; most nurses (78%) reported they were prepared to cooperate in administering life-ending drugs in some cases. Most (89%) favored adapting the law, making life termination of children legally possible in certain cases. Conclusions Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.

Caso belga de eutanásia em crianças: solução ou problema?

“…This disparity may be due to differences in how the cases are reported, and this information about the number of requests for euthanasia in minors in Belgium might not be reliable. 6,8,9 .…”

“…Over a third of all deaths are preceded, in several european countries, by end-of-life medical decisions 6 . The assignment or suspension of treatments and the relief of severe symptoms are generally considered common medical practice 7 .…”

“…Therefore, minor patients and their families may have to face the reality of death in childhood 6 . The child, as a vulnerable individual, requires special care and, for this reason, end-of-life medical decisions concerning minors represent additional clinical and ethical challenges.…”

“…Studies show that 5,6,14 most end-of-life care of children occurs in hospitals, especially in pediatric intensive care units (PICU). The decision to suspend the life support treatment is the most common -30% to 60% of deaths in the PICU are preceded by a process of active suspension, usually starting with The Belgian case of euthanasia for children, solution or problem?…”

“…Sedatives and analgesics are also regularly used, mainly after the decision to withdrawal treatment, emphasising the patient's comfort and palliation of symptoms 5,6,14 . In about 3% of the cases, the death of the child is preceded by an euthanasia request (about a third of the cases are requested by the minor and the rest is requested by the family) 6 .…”