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J Med Ethics doi:10.1136/medethics-2011-100428
  • Clinical ethics
  • Paper

The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan

  1. Yue-Cune Chang5
  1. 1School of Nursing, China Medical University, Taichung, Taiwan
  2. 2Diversion of Neonatology, Taichung Veterans General Hospital, Taichung, Taiwan
  3. 3Nursing College, Central Taiwan University of Science and Technology, Taichung, Taiwan
  4. 4Nursing Department, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
  5. 5Department of Mathematics, Tamkang University, Danshui, Taiwan
  1. Correspondence to Professor Niang-Huei Peng, Nursing College, Central Taiwan University of Science and Technology, No.666 Pu-tzu Road Betiun District, Taichung city 40601, Taiwan; lilyflower.nature{at}gmail.com
  • Received 5 December 2011
  • Revised 1 April 2012
  • Accepted 9 April 2012
  • Published Online First 5 May 2012

Abstract

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.

Footnotes

  • Competing interests None.

  • Patient consent All research participants (neonatal professionals) had signed the consent forms before the research.

  • Ethics approval The Committees for the Protection of Human Subjects of Research Hospital approved the conduct of this research.

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

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