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National ethical directives and practical aspects of forgoing life-sustaining treatment in newborn infants in a Swiss intensive care unit
- Source :
- Swiss Medical Weekly, Vol. 136, No 37-38 (2006) pp. 597-602
- Publication Year :
- 2006
-
Abstract
- How do actual aspects of forgoing life supporting therapy (LST) in newborn infants compare with national ethical directives in a Swiss intensive care unit?A prospective set of data on deaths after forgoing LST over a three year period in a single intensive care unit is analysed in view of the directives issued by the Swiss Academy for Medical Sciences (SAMS).Thirty-four newborn infants died after a decision to forgo LST, 21 after withdrawing and 13 after withholding. The decision making process was confined to the caregivers' team. Parents rarely initiated the discussion but participated in all decisions and were considered as willing in 32% and consenting in 68%. Futility was invoked in 79% of cases and poor developmental outcome in 21%. Respiratory support was forgone in 59%, circulatory support in 6% and both in 35%. The mother assisted the child at the time of death in 91%. At that time, 82% of infants were receiving opiates and 18% benzodiazepines, some in a higher than usual dose. Death occurred at a median of 13 (25-75% = 6-25) minutes after withdrawing LST and 70 (27.5-147.5) after withholding (p0.001) without correlation with the dose of analgesic or sedative administered. None of these observations obviously departed from the Swiss ethical directives.Practices surrounding forgoing LST in newborn infants in a Swiss intensive care unit match ethical directives. Factors leading to occasional use of unusually high dose of analgesic and sedative drugs remain to be identified.
- Subjects :
- medicine.medical_specialty
education
Decision Making
Gestational Age
Decision Making/ethics
law.invention
Life sustaining treatment
Nursing
law
Intensive Care Units, Neonatal
medicine
Humans
Intensive care medicine
health care economics and organizations
ddc:618
business.industry
Health Policy
Infant, Newborn
General Medicine
Intensive Care Units, Neonatal/ethics
Intensive care unit
Life Support Care
Ethical Directives
Ethics, Clinical
Withholding Treatment
Euthanasia, Active
Withholding Treatment/ethics
Life Support Care/ethics
Guideline Adherence
business
Medical Futility
Switzerland
Subjects
Details
- ISSN :
- 14247860
- Volume :
- 136
- Issue :
- 37-38
- Database :
- OpenAIRE
- Journal :
- Swiss medical weekly
- Accession number :
- edsair.doi.dedup.....e51af5fde4ab32ecd3dac32a44c6489c