Study in the Archives of Pediatric and Adolescent Medicine:
Setting: The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006.
Patients: All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths.
Results: An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants.
Conclusions: Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.
Editor: The main researcher, Dr. Eduard Verhagen, has spoken about his experiences as a doctor who administers lethal injections to babies in this Times Online article: 'In the baby's last seconds you see the pain relax and then they fall asleep.' How objective is he in this study? And how does he differentiate between 'deliberate ending of life' and 'withdrawal of life-sustaining therapy'? See also Conflicts About End-of-Life Decisions in NICUs in the Netherlands.
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