The French Society of Neonatology’s Proposals for Neonatal End-of-Life Decision-MakingDageville C. · Bétrémieux P. · Gold F. · Simeoni U. · for the Working Group on Ethical Issues in Perinatology1
aNeonatal Intensive Care Unit, Division of Pediatrics, University Hospital, Nice, bPediatric and Neonatal Intensive Care Unit, Division of Pediatrics, University Hospital, Rennes, cDivision of Neonatology, Paris 6 University Hospital, Paris, and dDivision of Neonatology and Espace Ethique Méditerranéen, Assistance Publique Hôpitaux de Marseille and Université de la Méditerranée, Marseille, France
Background: 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. Objectives: To propose a set of recommendations on the ethical principles to be respected in the making and application of end-of-life decisions. Methods: A multidisciplinary working group on ethical issues in perinatal medicine composed of neonatologists, obstetricians and ethicists. Results: 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. Conclusions: 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.