Neonatal Intensive Care Unit, Division of Pediatrics, University Hospital, Nice, France.
Neonatology. 2011;100(2):206-14. doi: 10.1159/000324119. Epub 2011 Apr 1.
Opinions and practice regarding end-of-life decisions in neonatal medicine show considerable variations between countries. A recent change of the legal framework, together with an ongoing debate among French neonatologists, led the French Society of Neonatology to reconsider and update its previous recommendations.
To propose a set of recommendations on the ethical principles to be respected in the making and application of end-of-life decisions.
A multidisciplinary working group on ethical issues in perinatal medicine composed of neonatologists, obstetricians and ethicists.
Withholding or withdrawing life-sustaining treatment may be acceptable, and unreasonable therapeutic obstinacy is condemned. This implies that the child's best interests must always be the central consideration. Although the parents must be involved in the decision process so that they form an alliance with the healthcare team, and a collegial approach is of utmost importance, any crucial decision affecting the patient's life calls for individual medical responsibility. Because every newborn is rightfully an integral member of a human family, his or her dignity must be preserved. The goal of palliative care is to preserve the quality of a life, also at its end. The intention underlying an act has to be analyzed perceptively. Euthanasia, i.e. to perform an act with the deliberate intention to cause or hasten a patient's death, is legally and morally forbidden. Conversely, to withhold or withdraw a life-sustaining treatment can be justified when the intention is to cease opposing, in an unreasonable manner, the natural course of a disease.
This statement provides the principles identified by French neonatologists on which to base their decisions concerning the ending of life. Arguments are set forth, discussed and compared with international statements and previously published considerations.
在新生儿医学领域，关于生命末期决策的意见和实践在各国之间存在相当大的差异。最近法律框架的改变，以及法国新生儿科医生之间的持续争论，促使法国新生儿学会重新考虑并更新其先前的建议。
提出一套关于在制定和应用生命末期决策时应遵守的伦理原则的建议。
一个由新生儿科医生、产科医生和伦理学家组成的围产期医学伦理问题多学科工作组。
可以接受停止或撤回维持生命的治疗，并且谴责不合理的治疗固执。这意味着儿童的最佳利益必须始终是核心考虑因素。尽管父母必须参与决策过程，以便他们与医疗团队结盟，并且团结合作至关重要，但任何影响患者生命的关键决策都需要个人承担医疗责任。因为每个新生儿都是一个人类家庭的合法成员，所以必须维护其尊严。姑息治疗的目的是保留生命的质量，即使在生命的尽头。必须敏锐地分析行为的意图。安乐死，即故意实施导致或加速患者死亡的行为，在法律和道德上都是禁止的。相反，当意图是不合理地停止对抗疾病的自然进程时，可以合理地停止或撤回维持生命的治疗。
这份声明提供了法国新生儿学家在决定生命终结时所依据的原则。提出了论点，进行了讨论，并与国际声明和以前发表的考虑进行了比较。
