(Pediatrics 2007;e20-e28)

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Medical End of Life decisions was defined as medical decisions with the effect or the probable effect that death was hastened. These decisions include the decisions to withhold or withdraw life-prolonging treatment and the decision to end deliberately the life of a newborn.

Newborns at the time of each EoL decision:Group 1, no chance to survive (NCTS) Group 2, theoretical chance to survive, very poor prognosis (PP)Group 3, stable, hopeless prognoses with severe suffering, not depending on intensive care

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Withholding treatment was defined as withholding potentially life-saving treatment, which included not only withholding cardiopulmonary resuscitation but also not providing additional intensive care treatment (eg, not making additional ventilator changes despite hypoxemia, not providing additional catecholamines despite hypotension).Withdrawing treatment was taken to be equivalent to withdrawing life-sustaining treatment (eg, withdrawing the ventilator). Deliberate ending of life was defined as administeringlethal drugs with the purpose to end the life or shorten the life of a newborn who is otherwise stable.

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In the Netherlands, physicians are rarely prosecuted when they end the life of a severely ill infant when they have applied the following requirements for prudent practice:

(i) the child suffers hopelessly and unbearably(ii) parents approve of the decision(iii) Independent physicians are consulted(iv) the physician performs the ending of life according to professional standards

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Decision making and modes of death in a tertiary neonatal unit (Arch Dis Child Fetal Neonatal Ed 2004;89:F527–F530)

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