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Dutch pediatricians’ views on the use of neuromuscular blockers for dying neonates: a qualitative study

Journal of Perinatology volume 35, pages 497–502 (2015)Cite this article

Subjects

Abstract

Objective:

To assess Dutch pediatricians’ views on neuromuscular blockers for dying neonates.

Study design:

Qualitative study involving in-depth interviews with 10 Dutch pediatricians working with severely ill neonates. Data were analyzed using appropriate qualitative research techniques.

Result:

Participants explained their view on neuromuscular blockers for neonates with a protracted dying process. Major themes were the interpretation of gasping, the role of (the suffering of) the parents, the need for judicial review and legislation’s impact on the care participants provide for dying neonates.

Conclusion:

The interviews show no consensus between pediatricians and provide insights into the points of disagreement. Interviews also suggest friction between the convictions of pediatricians and legislation, which seems to have an undesirable impact on Dutch care for dying neonates and their parents. This study raises important questions for pediatricians worldwide to reflect upon, such as: ‘what constitutes ‘dying well’?’ and ‘what role should the parents’ perspective play?’.

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Acknowledgements

We thank all the interviewed pediatricians for their participation in this study. We especially appreciate the sincerity and openness with which they talked to us about this sensitive aspect of their work. We also want to thank the other members of our research team who participated in the evaluation of the ‘legal provision for late termination of pregnancy and deliberately ending the life of a neonate’: Ineke Bolt (PhD) from the Medical Ethics and Philosophy department of the Erasmus Medical Center Rotterdam, who conducted some interviews and helped with the analysis of data, Agnes van der Heide (MD, PhD, Professor) from the department of Public Health of the Erasmus Medical Center Rotterdam, who, as project leader, advised us on several issues during the project and also gave commentary on a draft version of this article and Sjef Gevers (LL.M, PhD, Professor) from the department of Public Health of the Academic Medical Center Amsterdam who was concerned with the legal themes of the project. Eduard Verhagen (MD, PhD, Professor) from the University Medical Center Groningen is acknowledged for his advice on the project and his commentary on a draft version of this article. Finally, we thank ZonMw and NVVE who funded this research. Data collection was funded by ZonMw (The Netherlands Organization for Health Research and Development). KtC wrote the first draft of this article during an appointment at the Academic Medical Center Amsterdam. This appointment was funded by the NVVE (right-to-die-NL). Both ZonMw and NVVE had no role in the design, the collection, analysis and interpretation of the data, the reporting of this work, or the decision to submit the work for publication.

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Authors and Affiliations

  1. Department of General Practice, Section Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    K ten Cate

  2. Department of Medical Ethics and Philosophy, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands

    S van de Vathorst

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  1. K ten Cate
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Correspondence to K ten Cate.

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ten Cate, K., van de Vathorst, S. Dutch pediatricians’ views on the use of neuromuscular blockers for dying neonates: a qualitative study. J Perinatol 35, 497–502 (2015). https://doi.org/10.1038/jp.2014.238

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