Relationship of neonatologists' end-of-life decisions to their personal fear of death.

OBJECTIVE

To study the relationship of Australian and New Zealand (ANZ) neonatologists' personal fear of death to their forgoing life-sustaining treatment and hastening death in newborns destined for severe disability and newborns for whom further treatment is considered non-beneficial or overly burdensome.

DESIGN

A self-report questionnaire survey of ANZ neonatologists.

SETTING

Neonatologists registered in the 2004 ANZ Directory of Neonatal Intensive Care Units.

PARTICIPANTS

78 of 138 (56%) neonatologists who responded to the study questionnaire.

MAIN OUTCOME MEASURES

Between-group differences in the Multidimensional Fear of Death Scale.

RESULTS

In newborns for whom further treatment was deemed futile, 73 neonatologists reported their attitude to hastening death as follows: 23 preferred to hasten death by withdrawing minimal treatment, 35 preferred to hasten death with analgesia-sedation, and 15 reported that hastening death was unacceptable. Analysis of variance showed a statistically significant difference between the three groups regarding fear of the dying process (F = 3.78, p = 0.028), fear of premature death (F = 3.28, p = 0.044) and fear of being destroyed (F = 3.20, p = 0.047). Post hoc comparisons showed that neonatologists who reported that hastening death was unacceptable compared with neonatologists who preferred to hasten death with analgesia-sedation had significantly less fear of the dying process and fear of premature death, and significantly more fear of being destroyed.

CONCLUSIONS

ANZ neonatologists' personal fear of death and their attitude to hastening death when further treatment is considered futile are significantly related. Neonatologists' fear of death may influence their end-of-life decisions.