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Neonatal end-of-life decisions and ethical perspectives

Authors
  • Soltani Gerdfaramarzi, Madjid
  • Bazmi, Shabnam
Type
Published Article
Journal
Journal of Medical Ethics and History of Medicine
Publisher
Tehran University of Medical Sciences
Publication Date
Dec 05, 2020
Volume
13
Identifiers
DOI: 10.18502/jmehm.v13i19.4827
PMID: 33552452
PMCID: PMC7838882
Source
PubMed Central
Keywords
Disciplines
  • Review Article
License
Unknown

Abstract

End-of-life decisions are usually required when a neonate is at high risk of disability or death, and such decisions involve many legal and ethical challenges. This article reviewed the processes of ethical decision-making for severely ill or terminal neonates, considering controversial issues including the followings: ( i ) identifying primary decision makers, ( ii ) the role of law and guidelines, and ( iii ) changes in treatment controversy, law and regulations over twenty years in several European countries such as Switzerland, Germany, Italy, United Kingdom, France, the Netherlands, Sweden, and Spain. This review study conducted on accessible articles from PubMed, Google Scholar, Web of Science and Scopus databases. Based on two studies in 2016 and 1996, neonatologists reported that withholding intensive care, withdrawing mechanical ventilation or life-saving drugs, and involvement of parents in decision-makings have become more acceptable as time passes, indicative of trend change. Trend of physicians on how end the life of neonates, at risk of death, varies in different countries, and cultural factors, parents’ involvement in decisions and gestational age are factors considered in end-of-life decision-making. Future investigations continuously need to identify upcoming ethical aspects of proper decision-making.

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