Decisions About Periviable Babies in Dutch Neonatal Intensive Care Units; Quality-of-Life and Quality-of-Death Concerns

Abstract

A substantial number of reports and studies in the last 10-15 years have described the physician’s attitude towards neonatal EoL decisions and medical practice in the Netherlands. Legal developments have supported the concept that the decision to withholding and withdrawing life-sustaining treatment in newborns can be regarded normal medical practice. Deliberate ending of life, however, is labeled as an extraordinary category of medical actions, both medically and legally, that requires reporting and review as described in the Groningen Protocol. A recent study has indicated that reports have become increasingly rare. This might be because deliberate life-ending has become virtually non-existent, or it might still occur unreported because it’s unclear to the physicians where the demarcation between ‘good’ palliative care and deliberate life-ending lies. The medical profession should and could work together to get this issue cleared up. Keywords: End-of-life decisions, neonatology, intensive care, ethics, comfort medications, neonatal euthanasia