Neonatal End-of-Life Decision Making: The Possible Behavior of Greek Physicians, Midwives, and Nurses in Clinical Scenarios.

Antonios Poulios,Maria Dagla,Vasiliki Petousi

doi:10.3390/ijerph18083938

Abstract

Background: This study investigates the acceptability, bioethical justification, and determinants of the provision of intensive care to extremely preterm or ill neonates among healthcare professionals serving in NICUs in Greek hospitals. Methods: Healthcare professionals (71 physicians, 98 midwives, and 82 nurses) employed full-time at all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece were asked to report their potential behavior in three clinical scenarios. Results: The majority of healthcare professionals would start and continue intensive care to (a) an extremely preterm neonate, (b) a full-term neonate with an unfavorable prognosis, and (c) a neonate with complete phocomelia. In cases (a) and (b), midwives and nurses compared to physicians (p = 0.009 and p = 0.004 in scenarios (a) and (b), respectively) and health professionals ascribing to the quality-of-life principle compared to those ascribing to the intrinsic value of life (p = 0.001 and p = 0.01 scenarios (a) and (b) respectively), tend towards withholding or withdrawing care. Religion plays an important role in all three scenarios (p = 0.005, p = 0.017 and p = 0.043, respectively). Conclusions: Understanding healthcare professionals’ therapeutic intensiveness in the face of NICU ethical dilemmas can improve NICU policies, support strategies, and, consequently, the quality of neonatal intensive care.

Highlights

The rapid development of medical knowledge and technology in the field of neonatal care and the improvement of living standards over recent decades have brought about significant positive changes in the epidemiological indicators related to neonatal survival worldwide [1,2,3,4]
In light of the above, in the present empirical study, we investigate the acceptability, bioethical justification, and sociocultural and professional determinants of the provision of aggressive intensive care to extremely preterm or ill neonates among healthcare professionals serving in Neonatal Intensive Care Units (NICUs) in Greek hospitals
Responses to the first clinical scenario showed that the majority of Greek healthcare professionals (93.5%) are positive towards resuscitation and provision of intensive care to the extremely preterm neonate

Summary

Introduction

The rapid development of medical knowledge and technology in the field of neonatal care and the improvement of living standards over recent decades have brought about significant positive changes in the epidemiological indicators related to neonatal survival worldwide [1,2,3,4]. The severe disabilities of these neonates and their very poor prognosis raise significant concerns within the international scientific community [13,14,15]. In such situations, a critical question arises: Is the goal of medical care provision achieved for these neonates? This study investigates the acceptability, bioethical justification, and determinants of the provision of intensive care to extremely preterm or ill neonates among healthcare professionals serving in NICUs in Greek hospitals. Methods: Healthcare professionals (71 physicians, 98 midwives, and 82 nurses) employed full-time at all public Neonatal Intensive Care Units (NICUs). Conclusions: Understanding healthcare professionals’ therapeutic intensiveness in the face of NICU ethical dilemmas can improve NICU policies, support strategies, and, the quality of neonatal intensive care

Methods

Results

Discussion

Conclusion