De Proost L, Verweij E J T, Ismaili M'hamdi H, Reiss I K M, Steegers E A P, Geurtzen R, Verhagen A A E
Department of Medical Ethics, Philosophy and History of Medicine, Rotterdam, Netherlands.
Department of Neonatology, Rotterdam, Netherlands.
Front Pediatr. 2021 Feb 1;9:634290. doi: 10.3389/fped.2021.634290. eCollection 2021.
The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.
荷兰现行的围产期生存边缘护理指南建议，对于孕周24周及以上出生的婴儿，考虑开始积极护理。但这仅在对未出生婴儿的父母进行广泛咨询并共同决策之后。与大多数其他欧洲关于此事的指南相比，荷兰指南可能因其启动积极护理的年龄阈值相对较高、24周和25周这一灰色地带（在此期间积极管理由父母自行决定）以及在极端早产情况下对提供积极护理略有犹豫而显得突出。在本文中，我们将更深入地探讨荷兰的立场。首先，我们简要回顾一下荷兰以前和现行的指南。其次，我们将它们置于荷兰的社会文化背景中。我们关注荷兰对个人自由的优先重视、堕胎法和围产期生存阈值，以及文化中对痛苦的厌恶。最后我们探讨荷兰指南的两种可能调整；即，仅降低考虑启动积极护理的年龄阈值，或改变指南类型。
