The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan

Abstract

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.

Investigation of Neonatal Staff Members' Attitudes toward End-of-Life Decision Making about Dying Newborns

“…However, they disagreed with administering drugs for the purpose of ending life, withholding neonatal intensive care (i.e., resuscitation at birth or mechanical ventilation), and withdrawing mechanical ventilation. In other words, the respondents agreed more with using conservative, rather than active, interventions in relation to end-of-life decision making about dying neonates; these results are similar to the findings obtained from studies conducted in other Asian countries 9,11) . In contrast, our results differ from those obtained from studies conducted in European countries, where many doctors agreed with using active interventions, such as withdrawal of mechanical ventilation 8,[12][13][14][15] .…”

“…Although the respondents replied that it was necessary to suggest to parents of dying neonates that they sign DNR orders (62.7%), the agreement rate was much lower than that observed in another study (86.5%) 9) . Moreover, in this study, we also observed a clearer tendency toward the respondents finding it difficult or wanting to refrain from suggesting DNR orders or obtaining consent from families in person 9) .…”

“…Moreover, in this study, we also observed a clearer tendency toward the respondents finding it difficult or wanting to refrain from suggesting DNR orders or obtaining consent from families in person 9) . Over half (50.8%) of our respondents agreed that DNR order recommendations should first be approved by clinical ethics committees, which is lower The DNR informed consent form in your hospital is dear to you 57.8…”

“…Over half of the respondents agreed that recommendations to parents of dying neonates that they sign DNR orders should first be approved by clinical ethics committees (Table 3). than the rates observed in other studies (61.5% and 94.2%) 9,11) .…”

“…Six categories were used to assess the respondents' opinions and attitudes toward DNR orders for dying newborns 9,10) . Respondents were asked to indicate whether they strongly agreed, somewhat agreed, were unsure, somewhat disagreed, or strongly disagreed with each category.…”