Using potentially life-shortening drugs in neonates and infants.

OBJECTIVE

To describe the frequency, background, and impact of decisions to give analgesic or other drugs that may, intentionally or unintentionally, shorten the life-span of severely ill neonates.

SETTING

The Netherlands.

DESIGN

Retrospective, cross-sectional study.

PATIENTS

Questionnaires were mailed in The Netherlands to physicians reporting 338 consecutive deaths of infants under 1 yr of age from August through November 1995.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Questions were asked about medical end-of-life decisions preceding the death of the infant and about the decision-making process. Potentially life-shortening drugs, mostly opioids, were given in 37% of all deaths. The estimated effect in terms of the shortening of life was <1 wk in 72% of all patients in whom the administration of potentially life-shortening drugs had been the most important end-of-life decision. Most decisions to administer such drugs were discussed with parents and colleagues. The decisions were discussed regarding virtually all patients in whom the physician had intended to hasten death; doses of opioids tended to be larger in this group.

CONCLUSIONS

The frequency with which drugs that may shorten life are administered before the death of severely ill infants confirms the important role of modern medicine in dying in neonatology. Most physicians caring for neonates feel that palliative medication may be warranted in dying infants, even if it shortens life. A distinction between intentionally ending life and providing adequate terminal care by alleviating pain or other symptoms, which is important in moral and judicial terms, is probably not easily made for some of these patients.