Physicians’ attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey

Abstract

Background End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data. Methods A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach (scale 1–5). Results Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians’ educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p < 0.001) were factors that affected the attitude score. Conclusions Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform.

Neonatal End-of-Life Decision Making: The Possible Behavior of Greek Physicians, Midwives, and Nurses in Clinical Scenarios

“…The importance of religion as a parameter influencing ethical decision making in neonatal care has also been highlighted in the EURONIC project [ 41 ]. Similarly, other research has shown religious beliefs to be among the most common factors influencing cardiopulmonary resuscitation and neonatal intensive care decisions in extremely preterm neonates [ 47 , 48 , 49 ].…”

Withdrawal and withholding of life sustaining treatment (WWLST): an under recognised factor in the morbidity or mortality of periviable infants?—a narrative review

“…Differences in attitudes towards decision making at the end of life have also been noted between linguistic regions of Switzerland, with German-speaking parents preferring for the family to have the final call, while French- and Italian-speakers prefer physicians to have more decision making power ( 69 ). Religion, culture, racial bias and acceptance of diagnosis have also been cited in the literature as reasons for variation in decision making by neonatal teams ( 54 , 70 , 71 ). Personal biases might also play a role—clinicians who have children are more likely to be conservative in managing periviable infants ( 72 ).…”