Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e112-e119 (doi:10.1542/peds.2008-1839)
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ARTICLE

Conflicts About End-of-Life Decisions in NICUs in the Netherlands

A. A. Eduard Verhagen, MD, JD, PhDa, Mirjam de Vos, MScb, Jozef H. H. M. Dorscheidt, JD, PhDc, Bernadette Engels, RNa, Joep H. Hubben, JD, PhDc and Pieter J. Sauer, MD, PhDa

a Department of Pediatrics, Beatrix Children's Hospital
c Section of Health Law, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands
b Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands

OBJECTIVE: To determine the frequency and background of conflicts about neonatal end-of-life (EoL) decisions.

METHODS: We reviewed the medical files of 359 newborns who had died during 1 year in the 10 Dutch NICUs and identified 150 deaths that were preceded by an EoL decision on the basis of the child's poor prognosis. The attending neonatologists of 147 of the 150 newborns were interviewed to obtain details about the decision-making process.

RESULTS: EoL decisions about infants with a poor prognosis were initiated mainly by the physician, who subsequently involved the parents. Conflicts between parents and the medical team occurred in 18 of 147 cases and were mostly about the child's poor neurologic prognosis. Conflicts within the team occurred in 6 of 147 cases and concerned the uncertainty of the prognosis. In the event of conflict, the EoL decision was postponed. Consensus was reached by calling additional meetings, performing additional diagnostic tests, or obtaining a second opinion. The chief causes of conflict encountered by the physicians were religious convictions that forbade withdrawal of life-sustaining treatment and poor communication between the parents and the team.

CONCLUSIONS: The parents were involved in all EoL decision-making processes, and consensus was ultimately reached in all cases. Conflicts within the team occurred in 4% of the cases and between the team and the parents in 12% of the cases. The conflicts were resolved by postponing the EoL decision until consensus was achieved.

Key Words: decision-making • end of life • intensive care • neonatal death

Abbreviations: EoL—end of life

Accepted Mar 11, 2009.


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Home page
 Arch Pediatr Adolesc MedHome page
A. A. E. Verhagen, J. H. H. M. Dorscheidt, B. Engels, J. H. Hubben, and P. J. Sauer
End-of-Life Decisions in Dutch Neonatal Intensive Care Units
Arch Pediatr Adolesc Med, October 1, 2009; 163(10): 895 - 901.
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