Medical End-of-Life Decisions for Children in the Netherlands

Vrakking, Astrid M.; Heide, Agnes van der; Arts, W. F. M.; Pieters, Rob; Voort, Edwin van der; Rietjens, Judith; Onwuteaka‐Philipsen, Bregje D.; Maas, P.J. van der; Wal, Gerrit van der

doi:10.1001/archpedi.159.9.802

Cited by 45 publications

(44 citation statements)

References 27 publications

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“…Our study was the first investigation of the involvement of PICU nurses in end-of-life decisions and their attitudes toward those decisions in Belgium, a country where euthanasia has been legal for adults since May 2002. Unlike most earlier studies, in which nurses' involvement was measured through physicians' reports, 7,12 in our study, nurses working in PICUs were questioned in depth. Despite the illegal nature of some of the practices concerned, the response rate was rather satisfying.…”

Section: Discussionmentioning

confidence: 94%

“…3 Reports of studies on end-of-life decisions in children indicate that the decision to forgo life-sustaining treatment is the most frequently made decision, [5][6][7][8][9][10] that sedatives and analgesics are regularly used, 5,11 and that in about 3% of deaths, a child's death is preceded by the use of drugs explicitly intended to hasten death. 12 Explicit requests for drugs intended to hasten death (ie, euthanasia) have been allowed in Belgium since 2002, but only for adult patients and under strict precautions. 13 In recent years, however, whether euthanasia should be allowed for children 12 years and older has been under debate.…”

Section: Methods Study Design and Settingmentioning

confidence: 99%

“…Because we did not gather information about the drugs used and we did not ask the involved physicians about their intentions, we cannot be fully certain whether or not physicians would classify the cases similarly. 12 Nevertheless, we wanted to focus on the nurses' views and interpretation of the process of making and carrying out end-of-life decisions.…”

Section: Limitationsmentioning

confidence: 99%

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

Inghelbrecht¹,

Bilsen²,

Pereth³

et al. 2009

American Journal of Critical Care

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Methods Study Design and Settingmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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

Inghelbrecht¹,

Bilsen²,

Pereth³

et al. 2009

American Journal of Critical Care

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“…Studies conducted in Belgium and the Netherlands 8,28 reveal that, in most cases, the decision making is shared with the parents, but patients are rarely involved in the process, as incompetence of the minor is given as a justification(most often because of comatose state or because the child is too young). According to these studies, the decisions about treatment and medically assisted death are always discussed with the parents, which may result from the effect of short course of life in both cases.…”

Section: The Need For Pediatric Palliative Carementioning

confidence: 99%

Caso belga de eutanásia em crianças: solução ou problema?

Silva

Nunes

2015

Rev. Bioét.

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By extending its euthanasia law to minors in 2014, Belgium has fuelled the international debate on this issue. In fact, Medicine does not always have something to offer when it comes to a child's serious disease. Nevertheless, should euthanasia be considered a viable solution? Keeping in mind the Belgian reality, this article analyses the relevance of the new law, considering, on one hand, children's growing self-determination capacity and, on the other hand, their lack of "life experience". Let's not forget, in addition, classical arguments against euthanasia, such as the disrespect for the value of human life and the eventual approaching of the slippery slope. An obvious solution for this problem is the implementation of a proper palliative care system. However, evidence about the quality of pediatric end-of-life care is scarce. Therefore, additional investigation is necessary in order to formulate and propose an appropriate public policy on the matter. Keywords: Euthanasia. Child. Belgium. Palliative care. Resumo Caso belga de eutanásia em crianças: solução ou problema?A aprovação da extensão da prática da eutanásia a menores de idade em 2014, pela Bélgica, reacendeu o debate internacional sobre as decisões médicas em fim de vida em crianças. De fato, a medicina nem sempre tem resposta para a doença grave de uma criança. No entanto, será a eutanásia uma solução equacionável? Partindo da realidade belga, este artigo analisa a premência da nova legislação, considerando, por um lado, a capacidade crescente de autodeterminação das crianças e, por outro, a sua falta de "experiência de vida", não esquecendo argumentos clássicos que contrariam a prática da eutanásia, como o desrespeito pelo valor da vida humana e a eventual concretização do argumento da ladeira escorregadia. Uma solução óbvia passa pela realização de cuidados paliativos apropriados. Todavia, sendo escassa a evidência sobre a qualidade dos cuidados pediátricos em fim de vida, é necessária investigação adicional para que se possam formular e propor políticas públicas adequadas a respeito da matéria. Palavras-chave: Eutanásia. Criança. Bélgica. Cuidados paliativos. Resumen Caso belga de la eutanasia en niños, ¿solución o problema?La aprobación de la práctica de la extensión de la eutanasia a menores en 2014 por Bélgica ha reavivado el debate internacional sobre las decisiones médicas en el fin de la vida de los niños. De hecho, la medicina no siempre ha de responder a la enfermedad grave de un hijo. Sin embargo, ¿debería considerarse la eutanasia como una solución viable? Partiendo de la realidad belga, este artículo analiza la emergencia de la nueva ley: considerando, por un lado, la creciente capacidad de autodeterminación de los niños y, en segundo lugar, su falta de "experiencia de vida", sin olvidar los clásicos argumentos que contradicen la práctica de la eutanasia, como el desprecio por el valor de la vida humana y la eventual realización de "rampa de deslizamiento". Una solución obvia es implementar los cuidados paliativos adecuados. Si...

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“…Belgium and the Netherlands, but not Luxembourg, allow PAD for minors as well. 8,9 We know from systematic review and survey data that, in Belgium and the Netherlands, general practitioners and those specialized in care of the elderly carry out 43-66% of PAD. 3 Specialists are involved in 34-50% of the cases of assisted death; however, based on the literature, the types of specialists involved remain unclear.…”

mentioning

confidence: 99%