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Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol 2012 Nov;32(11):886-92

Date

12/17/2011

Pubmed ID

22173132

DOI

10.1038/jp.2011.186

Scopus ID

2-s2.0-84868518956   26 Citations

Abstract

OBJECTIVE: To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization.

STUDY DESIGN: American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information.

RESULT: In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts.

CONCLUSION: Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

Author List

Feltman DM, Du H, Leuthner SR

Author

Steven R. Leuthner MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Attitude of Health Personnel
Humans
Intensive Care Units, Neonatal
Life Support Care
Multivariate Analysis
Neonatology
Nutritional Support
Practice Patterns, Physicians'
Referral and Consultation
Terminal Care
Withholding Treatment