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Physician end-of-life decision-making in newborns in a less developed health care setting: insight in considerations
A A E Verhagen1, J Spijkerman, F D Muskiet
1Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. e.verhagen@bkk.umcg.nl
Insights
Physicians in developing countries make end-of-life decisions for newborns based on quality of life, similar to developed nations. These decisions are independent of post-discharge support availability for disabled infants.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Global Health
Background:
- Quality of life heavily influences end-of-life decisions for newborns.
- Previous studies focused on developed nations with robust neonatal intensive care unit (NICU) support.
- Limited data exists on end-of-life decision-making in developing healthcare settings.
Purpose of the Study:
- To investigate physician considerations in end-of-life decisions for sick newborns.
- To examine the practical implementation of these decisions in a less developed healthcare context.
Main Methods:
- Retrospective analysis of 32 deaths over 18 months in a neonatal unit.
- Focus on end-of-life decision-making processes and influencing factors.
Main Results:
- 75% of deaths resulted from withholding or withdrawing treatment.
- Quality-of-life considerations, including predicted suffering and dependency, drove 29% of these decisions.
- Legal, economic, and post-discharge support availability did not significantly influence most pediatricians' decisions.
Conclusions:
- Physician end-of-life decision-making in this developing healthcare setting mirrors practices in developed settings.
- Decisions are primarily based on predicted infant outcomes, irrespective of post-discharge care availability for disabled infants.
Background:
A substantial proportion of the decisions to withhold or withdraw life-prolonging treatment are based on the newborn's predicted poor quality of life. All previous studies on end-of-life decisions were done in countries with adequate support for disabled neonatal intensive care units (NICU) survivors. Data on quality-of-life considerations in countries with developing health care are not available yet.
Aim:
The aim of the study was to examine the considerations of physicians taking end-of-life decisions in sick newborns and how those decisions are carried out in practice in a less developed health care setting.
Method:
Thirty-two deaths over 18 months in a neonatal unit were retrospectively analyzed.
Results:
Twenty-four deaths (75%) were attributable to withholding or withdrawing of treatment. In 7 of these cases (29%), the decisions were based on quality-of-life considerations, mostly predicted suffering and expected hospital dependency. For the majority of paediatricians, end-of-life decision making was not influenced by legal or economic considerations or by considerations regarding availability of supportive care after discharge.
Conclusion:
Our study suggests that physician end-of-life decision making in this unit in a less developed health care setting is found to be similar to that in developed health care settings and is independent of availability of supportive care after discharge for infants with disabilities.
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