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. 2004 Jan;89(1):F19–F24. doi: 10.1136/fn.89.1.F19

Should euthanasia be legal? An international survey of neonatal intensive care units staff

M Cuttini, V Casotto, M Kaminski, I de Beaufort, I Berbik, G Hansen, L Kollee, A Kucinskas, S Lenoir, A Levin, M Orzalesi, J Persson, M Rebagliato, M Reid, R Saracci
PMCID: PMC1721640  PMID: 14711848

Abstract

Objective: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation.

Design: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom); 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively).

Main outcome measure: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now".

Results: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now.

Conclusions: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.

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Figure 1 .

Figure 1

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Doctors' opinions and self reported practice of euthanasia (defined as the administration of drugs with the purpose of ending the patient's life). Columns represent percentages of doctors; 95% confidence intervals are shown. The values for "Have ever been involved in a decision of active euthanasia" are taken from Cuttini et al.13

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashraf H. UK woman's right-to-die case fails. Lancet. 2001 Oct 27;358(9291):1437–1437. doi: 10.1016/S0140-6736(01)06547-3. [DOI] [PubMed] [Google Scholar]
  2. Cuttini M., Kaminski M., Saracci R., de Vonderweid U. The EURONIC Project: a European concerted action on information to parents and ethical decision-making in neonatal intensive care. Paediatr Perinat Epidemiol. 1997 Oct;11(4):461–474. doi: 10.1046/j.1365-3016.1997.d01-29.x. [DOI] [PubMed] [Google Scholar]
  3. Cuttini M., Nadai M., Kaminski M., Hansen G., de Leeuw R., Lenoir S., Persson J., Rebagliato M., Reid M., de Vonderweid U. End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries. EURONIC Study Group. Lancet. 2000 Jun 17;355(9221):2112–2118. doi: 10.1016/s0140-6736(00)02378-3. [DOI] [PubMed] [Google Scholar]
  4. Cuttini M., Rebagliato M., Bortoli P., Hansen G., de Leeuw R., Lenoir S., Persson J., Reid M., Schroell M., de Vonderweid U. Parental visiting, communication, and participation in ethical decisions: a comparison of neonatal unit policies in Europe. Arch Dis Child Fetal Neonatal Ed. 1999 Sep;81(2):F84–F91. doi: 10.1136/fn.81.2.f84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. De Leeuw R., Cuttini M., Nadai M., Berbik I., Hansen G., Kucinskas A., Lenoir S., Levin A., Persson J., Rebagliato M. Treatment choices for extremely preterm infants: an international perspective. J Pediatr. 2000 Nov;137(5):608–616. doi: 10.1067/mpd.2000.109144. [DOI] [PubMed] [Google Scholar]
  6. Doyal L., Doyal L. Why active euthanasia and physician assisted suicide should be legalised. BMJ. 2001 Nov 10;323(7321):1079–1080. doi: 10.1136/bmj.323.7321.1079. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Edwards S. J. Ethical debate: The distinction between withdrawing life sustaining treatment under the influence of paralysing agents and euthanasia. The doctrine of double effect is difficult but not impossible to apply. BMJ. 2001 Aug 18;323(7309):390–391. [PubMed] [Google Scholar]
  8. Emanuel E. J. Euthanasia: where the Netherlands leads will the world follow? No. Legalisation is a diversion from improving care for the dying. BMJ. 2001 Jun 9;322(7299):1376–1377. doi: 10.1136/bmj.322.7299.1376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Garel M., Gosme-Séguret S., Kaminski M., Cuttini M. Les prises de décisions éthiques en réanimation néonatale. Enquête auprès des soignants de deux centres français. Arch Pediatr. 1997 Jul;4(7):662–670. doi: 10.1016/s0929-693x(97)83370-2. [DOI] [PubMed] [Google Scholar]
  10. Lemeshow S., Letenneur L., Dartigues J. F., Lafont S., Orgogozo J. M., Commenges D. Illustration of analysis taking into account complex survey considerations: the association between wine consumption and dementia in the PAQUID study. Personnes Ages Quid. Am J Epidemiol. 1998 Aug 1;148(3):298–306. doi: 10.1093/oxfordjournals.aje.a009639. [DOI] [PubMed] [Google Scholar]
  11. McHaffie H. E., Cuttini M., Brölz-Voit G., Randag L., Mousty R., Duguet A. M., Wennergren B., Benciolini P. Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe. J Med Ethics. 1999 Dec;25(6):440–446. doi: 10.1136/jme.25.6.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Rebagliato M., Cuttini M., Broggin L., Berbik I., de Vonderweid U., Hansen G., Kaminski M., Kollée L. A., Kucinskas A., Lenoir S. Neonatal end-of-life decision making: Physicians' attitudes and relationship with self-reported practices in 10 European countries. JAMA. 2000 Nov 15;284(19):2451–2459. doi: 10.1001/jama.284.19.2451. [DOI] [PubMed] [Google Scholar]
  13. Sklansky M. Neonatal euthanasia: moral considerations and criminal liability. J Med Ethics. 2001 Feb;27(1):5–11. doi: 10.1136/jme.27.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Street K., Henderson J. Ethical debate: The distinction between withdrawing life sustaining treatment under the influence of paralysing agents and euthanasia. Are we treading a fine line? BMJ. 2001 Aug 18;323(7309):388–389. doi: 10.1136/bmj.323.7309.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Weber W. Netherlands legalise euthanasia. Lancet. 2001 Apr 14;357(9263):1189–1189. doi: 10.1016/S0140-6736(00)04400-7. [DOI] [PubMed] [Google Scholar]
  16. van der Heide A., van der Maas P. J., van der Wal G., Kollée L. A., de Leeuw R. Using potentially life-shortening drugs in neonates and infants. Crit Care Med. 2000 Jul;28(7):2595–2599. doi: 10.1097/00003246-200007000-00069. [DOI] [PubMed] [Google Scholar]
  17. van der Heide A., van der Maas P. J., van der Wal G., de Graaff C. L., Kester J. G., Kollée L. A., de Leeuw R., Holl R. A. Medical end-of-life decisions made for neonates and infants in the Netherlands. Lancet. 1997 Jul 26;350(9073):251–255. doi: 10.1016/S0140-6736(97)02315-5. [DOI] [PubMed] [Google Scholar]
  18. van der Wal G., Dillmann R. J. Euthanasia in The Netherlands. BMJ. 1994 May 21;308(6940):1346–1349. doi: 10.1136/bmj.308.6940.1346. [DOI] [PMC free article] [PubMed] [Google Scholar]

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