Physicians’ standpoints on end-of-life decisions at the neonatal intensive care units in Jordan

Abstract

The purpose of this cross-sectional descriptive study is to explore pediatricians’ and neonatologists’ attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns’ prognosis and the potential burden of the neonates’ disabilities on their families. The general attitude of the physicians (59–88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56–88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL–focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers’ efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan’s intensive care units.

Bioethical Decisions in Neonatal Intensive Care: Neonatologists’ Self-Reported Practices in Greek NICUs

“…In other studies, Guimarães et al [38] and Abdel Razeq [35] for example, additional factors predictive of physicians' practices have been identified; prominent among them are cultural and religious factors. Although religion was not revealed as a statistically significant variable predicting physicians' decision-making when faced with ethical dilemmas in neonatal intensive care, its relevance cannot be ignored in the context of the present study.…”

“…International studies have shown that the attitude and practices of healthcare professionals regarding ethical decision-making in intensive neonatal care differs significantly depending on the specific legal, economic, religious, historical, and general cultural conditions and characteristics of each country [35][36][37][38]. Country of origin emerges as the main differentiation factor of clinical behaviors pertaining to neonatal intensive care [37][38][39][40].…”

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

“…It has been shown that country of origin, cultural background and religious background influence physicians' attitudes and practice of medicine, including EOL care, although only in relatively few studies [6,7]. Some previous studies have shown that Muslim physicians are more likely than non-Muslim physicians to object to the concepts of withdrawal from life support or artificial nutrition, physician-assisted suicide, and terminal sedation [6,[8][9][10][11].…”

Physicians’ attitudes in relation to End-of-life Decisions in Neonatal Intensive Care Units: a national multicenter survey

“…Around 62%-93% of NICU deaths worldwide follow EoLDs as to withhold and primarily to withdraw treatment, thus affecting infant mortality. [12][13][14][15] Consequently, EoLDs should be considered in the evaluation of NICUs' treatment outcomes, as for survival in respect to the NICU's morbidity rate. 16 Recent literature provides valuable data on physicians' opinions, attitudes and end of life practices, particularly regarding long term morbidity of extremely premature infants.…”