Neonatal end-of-life decisions and ethical perspectives

Abstract

End-of-life decisions are usually required when a neonate is at high risk of disability or death, and such decisions involve many legal and ethical challenges. This article reviewed the processes of ethical decision-making for severely ill or terminal neonates, considering controversial issues including the followings: (i) identifying primary decision makers, (ii) the role of law and guidelines, and (iii) changes in treatment controversy, law and regulations over twenty years in several European countries such as Switzerland, Germany, Italy, United Kingdom, France, the Netherlands, Sweden, and Spain. This review study conducted on accessible articles from PubMed, Google Scholar, Web of Science and Scopus databases. Based on two studies in 2016 and 1996, neonatologists reported that withholding intensive care, withdrawing mechanical ventilation or life-saving drugs, and involvement of parents in decision-makings have become more acceptable as time passes, indicative of trend change. Trend of physicians on how end the life of neonates, at risk of death, varies in different countries, and cultural factors, parents’ involvement in decisions and gestational age are factors considered in end-of-life decision-making. Future investigations continuously need to identify upcoming ethical aspects of proper decision-making.

Attitudes Toward Neonatal Palliative Care Among Turkish Nurses and Physicians

“…It is reported that greater effort is needed to actively implement palliative care and promote palliative care practices across health disciplines 12,14 . Neonatal nurses, physicians, and families must cooperate in providing palliative care, and end-of-life care practices and support for grieving parents after an infant's death should be planned with multidisciplinary collaboration 11,16 …”

“…12,14 Neonatal nurses, physicians, and families must cooperate in providing palliative care, and end-of-life care practices and support for grieving parents after an infant's death should be planned with multidisciplinary collaboration. 11,16 Health professionals dealing with neonatal palliative care often experience emotional stress and ethical dilemmas that can adversely affect their attitudes toward end-of-life care. 17,18 Health care professionals caring for infants with terminal illness can experience the same emotions experienced by the infant's family, including anxiety, fear, guilt, anger, and depression.…”

Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act

“…Neonatal palliative care involves complex ethical and legal considerations, including issues related to decision-making about treatment and withdrawal of care, end-of-life care, bereavement support, and parental autonomy. Integrating these services into the healthcare system enables the establishment of ethical guidelines, protocols, and legislative frameworks that ensure that the best interests of neonates and their families are prioritized [ 16 ]. By incorporating neonatal palliative care into the Greek national healthcare system, end-of-life decision-making informed consent, and the reporting of certain conditions or circumstances, depending on the jurisdiction, will be strictly adhered to confidentiality, privacy, and laws, thus promoting a respectful and evidence-based approach.…”