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Dutch experience of monitoring active ending of life for newborns
  1. Hilde M Buiting1,
  2. Maartje A C Karelse2,
  3. Hens A A Brouwers3,
  4. Bregje D Onwuteaka-Philipsen4,
  5. Agnes van der Heide1,
  6. Johannes J M van Delden2
  1. 1Erasmus MC, Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2University Medical Center Utrecht, Julius Center for Health Sciences, Utrecht, The Netherlands
  3. 3Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4Department of Public and Occupational Health and Institute for Health and Care Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Hilde M Buiting, Erasmus MC, Department of Public Health, PO Box 2040, Rotterdam 3000 CA, The Netherlands; h.buiting{at}erasmusmc.nl

Abstract

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored.

Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry.

Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy.

Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed.

  • Attitudes towards death
  • care of the dying patient
  • newborns and minors
  • prolongation of life and euthanasia

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Footnotes

  • Funding This study was supported by a grant from ZonMW, the Netherlands Organization for Health Research and Development.

  • Competing interests None.

  • Ethics approval According to Dutch regulations ethics approval was not necessary for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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