Description
Despite the rapid technical innovations in neonatology, a considerable proportion of newborns still die shortly after birth. The death of many of these infants is often preceded by an end-of-life decision. End-of-life decisions are medical decisions with the effect or the probable effect that death is caused or hastened. They include the decision to withhold or withdraw life-sustaining treatment, as well as the decision to deliberately end a newborn’s life with lethal drugs.
Neonatal end-of-life decision-making is one of the most controversial areas of medicine as it raises all kinds of medical, ethical and legal questions regarding clinical management of severely ill newborns. End-of-life decisions in Dutch neonatal intensive care units examines these questions and provides a description of end-of-life decision-making practice in the Netherlands based on empirical studies by the author and his colleagues.
The first part of the book covers physician’s end-of-life decision-making considerations, including those leading to deliberate termination of life, the role of the parents and the use of medication as a part of end-of-life decisions. The last section covers a comparison of end-of-life decision-making in four NICU’s in the USA, Canada and the Netherlands followed by a reflection on the key aspects of Dutch neonatal end-of-life decision-making.
Contents
1 General introduction and outline of the thesis / 9
2 The Groningen protocol Euthanasia in severely ill newborns / 21
3 Physician medical decision-making at the end of life in newborns: insight into implementation at 2 Dutch centers / 29
4 End-of-life decisions in severely ill newborns in the Dutch NICU / 49
5 Differences of opinion regarding end-of-life decisions in severely ill newborns in the NICU; results of a nationwide study in the Netherlands / 65
6 Analgesics, sedatives and neuromuscular blockers as part of of-life decisions in Dutch NICU’s / 81
7 Categorizing neonatal deaths; a cross-cultural study in the USA, Canada and the Netherlands / 93
8 Summary and general discussion / 105
Summary in Dutch (Samenvatting in het Nederlands) / 119
Dankwoord / 125
Biography and Publications
About the author
Eduard Verhagen works as a pediatrician at the Beatrix Childrens Hospital, University Medival Center Groningen in the Netherlands.