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End-of-life decisions in delivery room and neonatal intensive care unit
Romaine Arlettaz1, Dieto Mieth, Hans-Ulrich Bucher
1Clinic of Neonatology, University Hospital, Zurich, Switzerland. romaine.arlettaz@usz.ch
Insights
Most neonatal end-of-life decisions in this center now follow an ethical framework, involving parents in 92% of cases. This structured approach ensures consistent care for critically ill newborns.
Area of Science:
- Neonatal medicine
- Medical ethics
- Pediatric critical care
Background:
- Increased neonatal survival rates have led to more long-term disabilities and ethical challenges.
- Developing ethical guidelines for end-of-life decisions in critically ill newborns is a global effort.
- A structured ethical decision-making framework has been used in this clinic for a decade.
Purpose of the Study:
- To assess end-of-life decision-making processes in a perinatal center.
- To determine the consistency of these decisions with an established ethical framework.
Main Methods:
- Evaluation of 199 consecutive neonatal deaths over a 5-year period.
- Analysis of adherence to a structured ethical decision-making framework.
Main Results:
- End-of-life decisions aligned with the ethical framework in 79% of cases.
- In 21% of cases, death occurred before the framework could be applied.
- Parents were involved in 92% of decisions and generally agreed with the outcomes.
Conclusions:
- In-hospital neonatal deaths are now typically preceded by structured, documented end-of-life decisions.
- This reflects a shift towards more formalized ethical considerations in neonatal care.
Background:
The increase in neonatal survival in recent decades has been followed by an increase in later disabilities. This has given rise to many new ethical issues. In different countries, efforts are being made to define ethical guidelines regarding withholding or withdrawing intensive care and end-of-life decisions in critically ill newborn infants. These guidelines have to be differentiated from ethical decision-making models which structure the process of decision making for an individual child. Such a framework has been in existence in our clinic for 10 years.
Aim:
The aims of this study were to evaluate how end-of-life decisions are taken in our perinatal centre and to analyse whether these decisions are consistent with our framework for structured ethical decision making.
Methods:
199 consecutive neonatal deaths over 5 y were evaluated.
Results:
In 157 cases (79%), end-of-life decisions were taken according to our ethical framework; in the remaining 42 cases (21%), the baby died before this could be done. In 92% of cases, parents were involved in the decision and, in all cases but one, agreed with the decision. A patient's life was never intentionally and actively terminated.
Conclusion:
In contrast to earlier years, in-hospital death in our clinic is nowadays usually preceded by structured and documented medical end-of-life decisions.
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