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Ethically complex decisions in the neonatal intensive care unit: impact of the new French legislation on attitudes and practices of physicians and nurses
  1. Micheline Garel1,
  2. Laurence Caeymaex2,3,
  3. François Goffinet1,
  4. Marina Cuttini4,
  5. Monique Kaminski1
  1. 1Inserm, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Villejuif, France
  2. 2Service de médecine néonatale, CHU Port Royal-Cochin, Paris, France
  3. 3Department of Research on Ethics, Etudes sur les sciences et les techniques, Paris Sud 11 University, Paris, France
  4. 4Unit of Epidemiology, Pediatric Hospital Bambino Gesù, Roma, Italy
  1. Correspondence to Micheline Garel, INSERM U 953, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France; micheline.garel{at}inserm.fr

Objectives A statute enacted in 2005 modified the legislative framework of the rights of terminally ill persons in France. Ten years after the EURONIC study, which described the self-reported practices of neonatal caregivers towards ethical decision-making, a new study was conducted to assess the impact of the new law in neonatal intensive care units (NICU) and compare the results reported by EURONIC with current practices.

Setting and design The study was carried out in the same two NICU as in the EURONIC qualitative study. A third centre was added to increase the sample size. From February to October 2007, 19 physicians and 17 nurses participated in semistructured interviews very similar to those for EURONIC. Content analysis identified the recurring themes emerging from the interviews.

Results Compared with the EURONIC results, the caregivers reported that they pay greater attention to the views of parents and provided respectful support to the neonates when life-sustaining treatment is withdrawn. Active termination of life has become exceptional. The possibility of withdrawal of treatment, the administration of sedatives to control pain even at the risk of hastening death, the emphasis on sparing parents the burden of decision, and the relative ignorance of the law were very similar to the EURONIC findings.

Conclusion Both the medical and the legal regulation of practices has allowed more dialogue with the parents and more humane care for dying newborns. A new European study is necessary to investigate the possible changes in practices and attitudes also in other countries.

  • Bills
  • care of dying minors
  • ethical dilemmas
  • EURONIC
  • health personnel
  • laws and cases
  • legislation
  • minors/parental consent
  • neonatal intensive care
  • newborns and minors
  • professionals
  • qualitative research

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Objectives A statute enacted in 2005 modified the legislative framework of the rights of terminally ill persons in France. Ten years after the EURONIC study, which described the self-reported practices of neonatal caregivers towards ethical decision-making, a new study was conducted to assess the impact of the new law in neonatal intensive care units (NICU) and compare the results reported by EURONIC with current practices.

Setting and design The study was carried out in the same two NICU as in the EURONIC qualitative study. A third centre was added to increase the sample size. From February to October 2007, 19 physicians and 17 nurses participated in semistructured interviews very similar to those for EURONIC. Content analysis identified the recurring themes emerging from the interviews.

Results Compared with the EURONIC results, the caregivers reported that they pay greater attention to the views of parents and provided respectful support to the neonates when life-sustaining treatment is withdrawn. Active termination of life has become exceptional. The possibility of withdrawal of treatment, the administration of sedatives to control pain even at the risk of hastening death, the emphasis on sparing parents the burden of decision, and the relative ignorance of the law were very similar to the EURONIC findings.

Conclusion Both the medical and the legal regulation of practices has allowed more dialogue with the parents and more humane care for dying newborns. A new European study is necessary to investigate the possible changes in practices and attitudes also in other countries.

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Footnotes

  • Funding INSERM.

  • Competing interests None.

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

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