Boize P, Borrhomee S, Michel P, Betremieux P, Hubert P, Moriette G
Réanimation néonatale, centre hospitalier René Dubos, 6, avenue Île-de-France, 95300 Pontoise, France.
Réanimation néonatale, centre hospitalier René Dubos, 6, avenue Île-de-France, 95300 Pontoise, France.
Arch Pediatr. 2019 Sep;26(6):330-336. doi: 10.1016/j.arcped.2019.06.007. Epub 2019 Jul 25.
Nearly 20 years ago the EURONIC study reported that French neonatologists sometimes deemed it legitimate to terminate the lives of newborn infants when the prognosis appeared extremely poor. Parents were not always informed of these decisions. Major change has occurred since then and is described herein.
A survey was conducted in the Île-de-France region, from 1 January to 31 January 2016. Professionals from 15 neonatal intensive care units (NICUs) were invited to complete a questionnaire.
A total of 702 questionnaires were collected and 670 responses were analyzed. Knowledge of the law differed according to professional status, with 71% of MDs (medical staff, MS), compared with 28% of nonmedical staff (NMS) declaring that they had good knowledge of the law. Most MDs and NMS believed that withholding or withdrawing life-sustaining treatments (WWLST) could be decided and implemented after a delay. Half of them thought that WWLST would always result in death. Although required by law, a consulting MD attended the collegial meeting required before deciding on WWLST in only half of the cases. Parents were almost always informed of the decision thereafter by the physician in charge of their infant. The most frequent disagreement with parents was observed when WWLST was the option selected. In this case, most professionals suggested postponing WWLST, continuing intensive care and dialogue with parents, aiming at a final shared decision. Major differences were observed between NICUs with regard to the withdrawal of artificial nutrition and hydration. Finally, 14% of MDs declared that infant active terminations of life still occurred in their NICU. Major differences concern WWLST and active termination of life, whose meaning has been partly modified since 2001.
Several major changes were observed in this survey: (1) treatment withdrawal decisions are made today in agreement with the law; (2) parents' information and involvement in the decision process have profoundly changed; (3) active termination of life (euthanasia) very rarely occurs; only at the end of a process in accordance with ethical principles and within the law is this decision made.
近20年前，EURONIC研究报告称，法国新生儿科医生有时认为，当预后看起来极差时，终止新生儿生命是合理的。父母并不总是被告知这些决定。从那时起发生了重大变化，本文对此进行了描述。
2016年1月1日至1月31日在法兰西岛地区进行了一项调查。邀请了15个新生儿重症监护病房（NICU）的专业人员填写一份问卷。
共收集到702份问卷，对670份回复进行了分析。对法律的了解因专业身份而异，71%的医生（医务人员，MS）宣称对法律有很好的了解，相比之下，只有28%的非医务人员（NMS）这样认为。大多数医生和非医务人员认为，在延迟一段时间后，可以决定并实施停止或撤除维持生命的治疗（WWLST）。他们中有一半人认为WWLST总会导致死亡。尽管法律有要求，但只有一半的情况下，在决定WWLST之前，会诊医生会参加所需的合议会议。此后，负责婴儿的医生几乎总会告知父母这一决定。当选择WWLST作为选项时，观察到与父母最常见的分歧。在这种情况下，大多数专业人员建议推迟WWLST，继续重症监护并与父母进行对话，目标是达成最终的共同决定。在撤除人工营养和水分方面，各NICU之间存在重大差异。最后，14%的医生宣称，他们所在的NICU仍存在主动终止婴儿生命的情况。主要差异涉及WWLST和主动终止生命，自2001年以来，其含义已部分改变。
本次调查观察到了几个重大变化：（1）如今，治疗撤除决定是依法做出的；（2）父母在决策过程中的信息告知和参与情况已发生深刻变化；（3）主动终止生命（安乐死）极少发生；只有在遵循伦理原则并在法律范围内的过程结束时才会做出这一决定。
