Background: Evaluation of the current practice of end-of-life decisions in neonates.

Methods: 1) 66 randomly sampled paediatricians were interviewed on their experience with and opinions on end-of-life decisions. Results were weighed for the proportions of neonatologists and general paediatricians represented in the sample. 2) For 312 consecutive neonatal deaths between august and november 1995, a questionnaire was sent to the responsible physician; 88% was returned. Results: Of all interviewed paediatricians, 73% had withdrawn and 50% had withheld treatment because of no survival chance, 66% had withdrawn and 34% had withheld treatment because of poor quality of later life. 34% ever administered drugs with the explicit intention of ending life, 21% would never do so. Parents were involved in the decision in 83% and colleagues were consulted in 86% of the cases. From the questionnaire, an end-of-life decision was made in 62% of the deaths. In 8% this was combined with drugs to hasten death. Half of the paediatricians were of the opinion that all cases of forgoing treatment should be reviewed for public control and the majority believed that independent doctors together with juridical and ethical experts would be the best equipped to perform this review. Conclusion: The finding of 62% end-of-life decisions in neonatal death cases is in line with recent studies from other countries.