End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey

Deliens, Luc; Mortier, Freddy; Bilsen, Johan; Cosyns, Marjan; Stichele, Robert Vander; Vanoverloop, Johan; Ingels, K.J.A.O.

doi:10.1016/s0140-6736(00)03233-5

Cited by 282 publications

(230 citation statements)

References 10 publications

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“…Depending on the country of origin, on the type of ICU and on patient age, the incidence of deaths that followed LSL decisions has ranged between 30 and 90%. [6][7][8][9][10][11] In this study, similar rates were found in three PICUs in southern Brazil.…”

Section: Discussionsupporting

confidence: 76%

“…6 Studies about modes of death at pediatric intensive care units (PICU), conducted in Europe and in the United States, showed an LSL incidence of 30 to 60%. [7][8][9][10][11] In Latin American countries, which use the principles of paternalistic medicine, too little research is carried out into end-of-life decisions, especially regarding pediatric patients. The death of an infant or child always involves a lot of grief.…”

Section: Introductionmentioning

confidence: 99%

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Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Lago¹,

Piva²,

Kipper³

et al. 2005

J. Pediatr. (Rio J.)

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Objectives: To describe causes of death and factors involved in the decision-making process related to life support limitation at three university-affiliated pediatric intensive care units in the south of Brazil.Methods: A retrospective study was conducted, based on a review of the medical records of all deaths occurring during 2002 at three pediatric intensive care units in Porto Alegre. Three previously trained pediatric fellows from each service performed the study. Data were assessed relating to general case characteristics, causes of death (failed cardiopulmonary resuscitation, brain death, do-not-resuscitate orders, withholding or withdrawing lifesustaining treatment -the last three modes were classified as the life support limitation group), length of stay in hospital, end-of-life plans and the participation of patients families and Ethics Committees. The Student t test, Mann Whitney, chi-square, odds ratio and multivariate analyses were used for comparisons.Results: Close to 53.3% of fatal cases had received full cardiopulmonary resuscitation. The incidence of life support limitation was 36%, with statistical differences (p = 0.014) between the three hospitals (25 versus 54.3 and 45.5%, respectively). The most frequent form of life support limitation was a do-not-resuscitate order (70%). Life support limitation was associated with the presence of chronic disease (odds ratio = 8.2; 95%CI 3.2-21.3) and length stay in the pediatric intensive care unit (odds ratio = 4.4; 95%CI 1.6-11.8). The rate of involvement of families and Ethics Committees in the decision-making process was lesser than 10%.Conclusions: Cardiopulmonary resuscitation is offered more frequently than is observed in northern countries. In contrast, life support limitation is offered through do-not-resuscitate orders. These findings and the low participation of the families in the decision-making process reflect the difficulties to be overcome by those professionals who are responsible for handling critically ill children in southern Brazil.J Pediatr (Rio J). 2005;81(2):111-7: Death, ethics, pediatric intensive care, forgoing life support, do-notresuscitate orders.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Lago¹,

Piva²,

Kipper³

et al. 2005

J. Pediatr. (Rio J.)

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show abstract

“…Seven units specialize in the care of seriously ill children. 24 G eneral medical studies [1][2][3][4] have indicated that end-of-life decisions with a possible or certain life-shortening effect are common in medical practice. Examples include decisions to withhold or withdraw potentially life-sustaining treatments, decisions to intensify pain and/or symptom alleviation with a possible lifeshortening side effect, and decisions to administer drugs explicitly intended to hasten death.…”

Section: Methods Study Design and Settingmentioning

confidence: 99%

“…In several European countries, more than one-third of all deaths are preceded by an end-of-life decision. 3 Reports of studies on end-of-life decisions in children indicate that the decision to forgo life-sustaining treatment is the most frequently made decision, [5][6][7][8][9][10] that sedatives and analgesics are regularly used, 5,11 and that in about 3% of deaths, a child's death is preceded by the use of drugs explicitly intended to hasten death. 12 Explicit requests for drugs intended to hasten death (ie, euthanasia) have been allowed in Belgium since 2002, but only for adult patients and under strict precautions.…”

Section: Methods Study Design and Settingmentioning

confidence: 99%

“…3,26,27 Content validity was established through expert review by a pediatrician working in a PICU, a nurse/health scientist, and a sociologist with experience in development of questionnaires on end-of-life care issues and through testing by 3 pediatric intensive care nurses; some minor adaptations were made to enhance clarity. Attention was paid to the interpretation of the different end-of-life decisions.…”

Section: Questionnairementioning

confidence: 99%

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Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Inghelbrecht¹,

Bilsen²,

Pereth³

et al. 2009

American Journal of Critical Care

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Objective To investigate Belgian pediatric intensive care nurses' involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect. Methods Questionnaires were distributed to 141 nurses working in 5 of the 7 pediatric intensive care units in Belgium. Nurses were asked to recall the last child in their care whose treatment involved an end-of-life decision and to describe anonymously their involvement in the decision. Attitudes were ascertained by means of statements and a Likert scale. Results Questionnaires were completed by 89 nurses (63%). During the preceding 2 years, 76 (85%) had cared for at least 1 child for whom a medical end-of-life decision had been made. Nurses were involved in initiating the decision in 17% of cases, participated in decision making in 50%, and played a role in carrying out the decision in 90%. Only 6% of nurses found it always ethically wrong to hasten the death of a child by administering lethal drugs; most nurses (78%) reported they were prepared to cooperate in administering life-ending drugs in some cases. Most (89%) favored adapting the law, making life termination of children legally possible in certain cases. Conclusions Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.

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Granted, Undecided, Withdrawn, and Refused Requests for Euthanasia and Physician-Assisted Suicide

Weide

Onwuteaka‐Philipsen²,

Wal³

2005

Arch Intern Med

111

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End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey

Cited by 282 publications

References 10 publications

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Granted, Undecided, Withdrawn, and Refused Requests for Euthanasia and Physician-Assisted Suicide

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