D M Feltman1, H Du, S R Leuthner. 1. Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA. dfeltman@northshore.org
Abstract
OBJECTIVE: To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. STUDY DESIGN: American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. RESULT: In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. CONCLUSION: Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.
OBJECTIVE: To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. STUDY DESIGN: American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. RESULT: In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. CONCLUSION: Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.
Authors: Robin Saoud; Devika Locke; Jessica T Fry; Nana Matoba; Ankur Datta; Robert DiGeronimo; Steven R Leuthner; Carl H Coghill; Girija Natarajan; Jason Z Niehaus; Amy Brown Schlegel; Julie Weiner; Narendra Dereddy; Anita Shah; Kevin M Sullivan Journal: J Perinatol Date: 2021-03-23 Impact factor: 2.521
Authors: Gillian C Pet; Ryan M McAdams; Lilah Melzer; Assaf P Oron; Simon P Horslen; Adam Goldin; Patrick J Javid Journal: J Pediatr Date: 2018-05-10 Impact factor: 4.406