203 The Mosaic Project: Ethical Decision-Making Policies of European Maternity and Neonatal Units

Abstract

Introduction: In the project Models of OrganiSing Access to Intensive Care for very preterm births in Europe (MOSAIC), the maternity and neonatal units policies towards ethical decision-making were explored. (1) Methods: Ten regions in Denmark, Belgium, France, Germany, Italy, the Netherlands, Poland, Portugal and UK participated. A total of 105 maternity and neonatal units with at least 5 annual births or admissions at 22–31weeks were surveyed by means of a structured questionnaire in 2003. Results: In 32/105 maternity and 31/105 neonatal units, written protocols for forgoing treatment of extremely preterm deliveries or newborns were available. In 50 of the 82 neonatal units where decisions to withdraw treatment are made, parents are involved in the decision-making. The minimum gestational age at which a caesarean section is performed varies. In most maternity units, the limit of 24 weeks (n=31), 25 weeks (n=16) or 26 weeks (n=18) is adopted in case of acute distress of a non-malformed foetus. In 22 units no policy exists. In cases where parents are against aggressive treatment only 17 units would perform a caesarean section before 26 weeks. Most maternity units (59/105) follow a policy of multidisciplinary decision-making about active resuscitation before 25 weeks of gestational age. In case of severe congenital anomalies, this proportion is even higher (83/105). In 62/105 hospitals, an ethics committee is available. However, in 24 the committee is never involved in clinical decision-making and in 27 only in selected cases. Conclusions: Twenty-four weeks of gestation is the most common lower limit of active treatment, although there are wide variations between individual units. Neonatologists usually participate in obstetrical decisions. Most neonatal units involve parents in ethical decision-making. Decisions usually are taken without consultation of ethics committees.