Dombrecht Laure, Deliens Luc, Chambaere Kenneth, Baes Saskia, Cools Filip, Goossens Linde, Naulaers Gunnar, Roets Ellen, Piette Veerle, Cohen Joachim, Beernaert Kim
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussel, Belgium.
Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
Acta Paediatr. 2020 Mar;109(3):494-504. doi: 10.1111/apa.14797. Epub 2019 Apr 12.
Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs.
A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail.
The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death.
There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making.
围产期死亡通常之前会有临终决定（ELD）。不同的医院政策、复杂的法律框架以及伦理难题使得态度变得很重要。本研究调查了新生儿科医生和护士对围产期ELD的态度。
2017年5月，对比利时弗拉芒地区所有8个新生儿重症监护病房的所有新生儿科医生和新生儿护士进行了一项调查。受访者通过李克特量表表明对有关围产期ELD陈述的同意程度，并通过邮件返还问卷。
回复率为49.5%（302/610）。大多数新生儿科医生和护士认为诸如停止或撤销治疗等不治疗决定是可以接受的（90%-100%）。在两组中，当胎儿存在严重或致命问题且具有生存能力时终止妊娠被认为是高度可接受的（80%-98%）。医生和护士对不同的ELD接受程度不同，例如，护士比医生更常（74%对60%，p = 0.017）同意在某些情况下为加速死亡而明确给药是可以接受的。
对于产前和新生儿期的ELD都有相当大的支持，即使是对于目前不属于比利时法律框架内的决定。新生儿科医生和护士态度的差异表明，在做出ELD决定时应听取双方的意见。
