Nurturing Futility in the NICU: The Dutch Perspective

Requests for life-prolonging treatments can cause irresolvable conflicts between health-care providers and surrogates. The Multiorganization Policy Statement (Bosslet et al. 2015) with recommendations to prevent and manage these conflicts creates a good opportunity to examine how end-of-life decisions are made in Dutch neonatal intensive care units and how medical futility is defined. The Dutch equivalent of medical futility in the context of NICU care has grown and developed rather independently, within the typical legal, ethical, and cultural framework of Dutch society. Moreover, intractable conflicts and legal claims about life-prolonging treatments of newborns are very rare. This makes the Multiorganization Statement recommendations only partly relevant to Dutch practice. Critics are right in their comments that a substitution for the term futility, as recommended in the statement, is unlikely to prevent or solve irresolvable conflicts. But the recommended transparency about limit setting may work well, provided physicians make sure that comfort and palliative care are always provided.