Citation

Vrakking AM, van der Heide A, Arts WFM, Pieters R, van der Voort E, Rietjens JA, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G. Arch. Pediatr. Adolesc. Med. 2005; 159(9): 802-809.

Affiliation

Department of Public Health, Erasmus MC and Erasmus MC-Sophia, Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands. a.vrakking@erasmusmc.nl

Copyright

(Copyright © 2005, American Medical Association)

DOI

10.1001/archpedi.159.9.802

PMID

16143738

Abstract

BACKGROUND: Most end-of-life decision-making studies have, until now, involved either the general population or newborn infants. OBJECTIVE: To assess the frequency of end-of-life decisions preceding child death and the characteristics of the decision-making process in the Netherlands. METHODS: Two studies were performed. The first was a death certificate study in which all 129 physicians reporting the death of a child aged between 1 and 17 years in the period August to December 2001 received a written questionnaire; the second was an interview study in which face-to-face interviews were held with 63 physicians working in pediatric hospital departments. RESULTS: Some 36% of all deaths of children between the ages of 1 and 17 years during the relevant period were preceded by an end-of-life decision: 12% by a decision to refrain from potentially life-prolonging treatment; 21% by the alleviation of pain or symptoms with a possible life-shortening effect; and 2.7% by the use of drugs with the explicit intention of hastening death. The latter decision was made at the child's request in 0.7% and at the request of the family in 2% of cases. The interview study examined 76 cases of end-of-life decision making. End-of-life decisions were discussed with all 9 competent and 3 partly competent children, with the parents in all cases, with other physicians in 75 cases, and with nurses in 66 cases. CONCLUSIONS: While not inconsiderable, the percentage of end-of-life decisions was lower for children than for adults and newborn infants. Most children are not considered to be able to participate in the decision-making process. Decisions are generally discussed with parents and other caregivers and, if possible, with the child.

Language: en