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Medical end-of-life decisions in neonates and infants in Flanders

(2005) LANCET. 365(9467). p.1315-1320
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Organization
Abstract
Background Paediatricians are increasingly confronted with end-of-life decisions in critically ill neonates and infants. little is known about the frequency and characteristics of end-of-life decisions in this population, nor about the relation with clinical and patients' characteristics. Methods A death-certificate study was done for all deaths of neonates and infants in the whole of Flanders over a 12-month period (August, 1999, to July, 2000). We sent an anonymous questionnaire by mail to the attending physician for each of the 292 children who died under the age of 1 year. Information on patients was obtained from national registers. An attitude study was done for all physicians who attended at least one death during the study period. Findings 253 (87%) of the 292 questionnaires were returned, and 121 (69%) of the 175 physicians involved completed the attitude questions. An end-of-life decision was possible in 194 (77%; 95% CI 70.4-82.4) of the 253 deaths studied, and such a decision was made in 143 cases (57%; 48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13% vs 3%; p=0.018). The attitude study showed that 95 (79%; 70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%; 48.1-66.5) of 120 supported legalisation of life termination in some cases. Interpretation Death of neonates and infants is commonly preceded by an end-of-life decision. The type of decision varied substantially according to the age of the child. Most physicians favour legalisation of the use of lethal drugs in some cases.
Keywords
INTENSIVE-CARE, SELF-REPORTED PRACTICES, EUROPEAN COUNTRIES, DANISH PHYSICIANS, NETHERLANDS, ATTITUDES, NEWBORNS, EUTHANASIA

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MLA
Provoost, Veerle, Filip Cools, Freddy Mortier, et al. “Medical End-of-life Decisions in Neonates and Infants in Flanders.” LANCET 365.9467 (2005): 1315–1320. Print.
APA
Provoost, Veerle, Cools, F., Mortier, F., Bilsen, J., Ramet, J., Vandenplas, Y., & Deliens, L. (2005). Medical end-of-life decisions in neonates and infants in Flanders. LANCET, 365(9467), 1315–1320.
Chicago author-date
Provoost, Veerle, Filip Cools, Freddy Mortier, Johan Bilsen, José Ramet, Yvan Vandenplas, and Luc Deliens. 2005. “Medical End-of-life Decisions in Neonates and Infants in Flanders.” Lancet 365 (9467): 1315–1320.
Chicago author-date (all authors)
Provoost, Veerle, Filip Cools, Freddy Mortier, Johan Bilsen, José Ramet, Yvan Vandenplas, and Luc Deliens. 2005. “Medical End-of-life Decisions in Neonates and Infants in Flanders.” Lancet 365 (9467): 1315–1320.
Vancouver
1.
Provoost V, Cools F, Mortier F, Bilsen J, Ramet J, Vandenplas Y, et al. Medical end-of-life decisions in neonates and infants in Flanders. LANCET. 2005;365(9467):1315–20.
IEEE
[1]
V. Provoost et al., “Medical end-of-life decisions in neonates and infants in Flanders,” LANCET, vol. 365, no. 9467, pp. 1315–1320, 2005.
@article{302121,
  abstract     = {Background Paediatricians are increasingly confronted with end-of-life decisions in critically ill neonates and infants. little is known about the frequency and characteristics of end-of-life decisions in this population, nor about the relation with clinical and patients' characteristics.
Methods A death-certificate study was done for all deaths of neonates and infants in the whole of Flanders over a 12-month period (August, 1999, to July, 2000). We sent an anonymous questionnaire by mail to the attending physician for each of the 292 children who died under the age of 1 year. Information on patients was obtained from national registers. An attitude study was done for all physicians who attended at least one death during the study period.
Findings 253 (87%) of the 292 questionnaires were returned, and 121 (69%) of the 175 physicians involved completed the attitude questions. An end-of-life decision was possible in 194 (77%; 95% CI 70.4-82.4) of the 253 deaths studied, and such a decision was made in 143 cases (57%; 48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13% vs 3%; p=0.018). The attitude study showed that 95 (79%; 70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%; 48.1-66.5) of 120 supported legalisation of life termination in some cases.
Interpretation Death of neonates and infants is commonly preceded by an end-of-life decision. The type of decision varied substantially according to the age of the child. Most physicians favour legalisation of the use of lethal drugs in some cases.},
  author       = {Provoost, Veerle and Cools, Filip and Mortier, Freddy and Bilsen, Johan and Ramet, José and Vandenplas, Yvan and Deliens, Luc},
  issn         = {0140-6736},
  journal      = {LANCET},
  keywords     = {INTENSIVE-CARE,SELF-REPORTED PRACTICES,EUROPEAN COUNTRIES,DANISH PHYSICIANS,NETHERLANDS,ATTITUDES,NEWBORNS,EUTHANASIA},
  language     = {eng},
  number       = {9467},
  pages        = {1315--1320},
  title        = {Medical end-of-life decisions in neonates and infants in Flanders},
  url          = {http://dx.doi.org/10.1016/S0140-6736(05)61028-8},
  volume       = {365},
  year         = {2005},
}

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