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Care of Critically Ill Infants and Children. The committee expressed concerns that the Baby Doe regulations had caused physicians to overuse LSMT. However, the committee suggested that the language used in the regulations “may permit more physician discretion than some realize.” The committee recommended parental involvement in decision making with physicians, using the principles of informed parental permission, and opposed clinical decision making on the basis of resource limitation (58).

End-of-Life Practices Abroad

European end-of-life practices vary by country, but there is great concern about the practice of active euthanasia in the Netherlands, France, and Belgium. A recent publication suggested a protocol designed to allow and regulate euthanasia of newborns in the Netherlands (59). In addition, infants at the border of viability (those born at less than 26 weeks gestation) are resuscitated much less frequently in the Netherlands than in other European countries and the United States. However, physicians in several European countries are uncomfortable with the practice of withholding or withdrawing life-sustaining treatments, according to the current literature.

EURONIC Data

The EURONIC research project has been carried out primarily in eight European countries and has amassed data via anonymous questionnaires on end-of-life practices and attitudes in neonatal intensive care self-administered to physicians and nurses.

In all countries, between 61 and 96 percent of the neonatologists reported that they had ever decided to limit intensive treatment. Between countries, a wide range of proportions of physicians withdrew ventilation, from a low of 23 percent in Italy to a high of 93 percent in the Netherlands. In that study, 86 percent of physicians in France and 45 percent of physicians in the Netherlands reported that they had given medications with the purpose of ending life. They conclude that variations in practice are culture and country dependent (60).

In a report that measured physicians’ attitudes regarding quality of life versus absolute value of life, the country of origin remained the strongest predictor of physician response. Attitude scores were higher (i.e., indicating a greater concern for quality of life) in the Netherlands, the United Kingdom, and Sweden and lower (indicating a greater concern for life in general) in Hungary, Estonia, Lithuania, and Italy. The group concluded that increased concern for quality of life was associated with physicians’ likelihood of reporting that they had ever set limits to intensive interventions. After controlling for potential confounders such as age, gender, years of



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