Belgian doctors treating critically ill infants favour legalising euthanasia

Most paediatricians in Flanders, Belgium, favour the legalisation of lethal drugs to end the life of some critically ill babies and infants, concludes a study in this week’s issue of The Lancet.

Doctors are increasingly confronted with end-of-life decisions in critically ill babies and infants. Little is known about the frequency of end-of-life decisions in this population, the clinical and demographic characteristics of these patients, and the attitudes of doctors who care for these patients.

Luc Deliens (Vrije Universiteit Brussel, Belgium) and colleagues looked at the death certificates for all neonates and infants in the whole of Flanders who died between August 1999 and July 2000. 292 children were born alive and died in Flanders within the first year of life over this period. 175 doctors in charge of these cases were identified and sent anonymous questionnaires. 121 of the 175 doctors involved completed the attitude questions.

An end-of-life decision was made in 143 cases (57%). End-of-life decisions include withdrawing or withholding treatment, using drugs to alleviate pain that could potentially shorten life, or using drugs with the explicit intention of shortening the patient’s life. The use of lethal drugs in minors is illegal in Belgium. However, the study found that lethal doses or lethal drugs were administered in 17 cases (9%). 95 (79%) of the 121 doctors thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%) of 120 supported legalisation of termination in some cases.

Professor Deliens states: “We found that about three in four physicians who are confronted with critically ill neonates and infants are willing to participate in certain forms of life termination in these children. The main reasons for shortening of the neonate’s life were the absence of real survival chances, and, if the baby survived, an expected very poor quality of life.”

Also in this week’s issue of The Lancet a Research Letter by Astrid Vrakking (University Medical Centre Rotterdam, Netherlands) and colleagues finds that the frequency of the active ending of life of infants has not risen in the Netherlands despite its new, more liberal, regulatory system of such actions.

In an accompanying Comment Chris Feudtner (Children’s Hospital of Philadelphia, USA) outlines five issues in the euthanasia debate. He states: “If we want a policy that would reduce acts of killing to a minimum, we need far better evidence from various practice settings about the impact of end-of-life-care policies on actual clinical practice.”