Skip to main content
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 1999 Dec;25(6):440–446. doi: 10.1136/jme.25.6.440

Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe.

H E McHaffie 1, M Cuttini 1, G Brölz-Voit 1, L Randag 1, R Mousty 1, A M Duguet 1, B Wennergren 1, P Benciolini 1
PMCID: PMC479290  PMID: 10635495

Abstract

Representatives from eight European countries compared the legal, ethical and professional settings within which decision making for neonates takes place. When it comes to limiting treatment there is general agreement across all countries that overly aggressive treatment is to be discouraged. Nevertheless, strong emphasis has been placed on the need for compassionate care even where cure is not possible. Where a child will die irrespective of medical intervention, there is widespread acceptance of the practice of limiting aggressive treatment or alleviating suffering even if death may be hastened as a result. Where the infant could be saved but the future outlook is bleak there is more debate, but only two countries have tested the courts with such cases. When it comes to the active intentional ending of life, the legal position is standard across Europe; it is prohibited. However, recognising those intractable situations where death may be lingering and unpleasant, Dutch paediatricians have reported that they do sometimes assist babies to die with parental consent. Two cases have been tried through the courts and recent official recommendations have set out standards by which such actions may be assessed.

Full text

PDF

Selected References

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

  1. Battin M. P. Assisted suicide: can we learn from Germany? Hastings Cent Rep. 1992 Mar-Apr;22(2):44–51. [PubMed] [Google Scholar]
  2. Campbell A. G., McHaffie H. E. Prolonging life and allowing death: infants. J Med Ethics. 1995 Dec;21(6):339–344. doi: 10.1136/jme.21.6.339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. 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]
  4. 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]
  5. Gillon R. Euthanasia, withholding life-prolonging treatment, and moral differences between killing and letting die. J Med Ethics. 1988 Sep;14(3):115–117. doi: 10.1136/jme.14.3.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Grassin M., Pochard F., Hervé C. End-of-life decisions in Dutch paediatric practice. Lancet. 1997 Sep 13;350(9080):817–817. doi: 10.1016/S0140-6736(05)62616-5. [DOI] [PubMed] [Google Scholar]
  7. Orlowski J. P., Smith M. L., Van Zwienen J. Pediatric euthanasia. Am J Dis Child. 1992 Dec;146(12):1440–1446. doi: 10.1001/archpedi.1992.02160240050019. [DOI] [PubMed] [Google Scholar]
  8. Truog R. D., Brett A. S., Frader J. The problem with futility. N Engl J Med. 1992 Jun 4;326(23):1560–1564. doi: 10.1056/NEJM199206043262310. [DOI] [PubMed] [Google Scholar]
  9. de Leeuw R., de Beaufort A. J., de Kleine M. J., van Harrewijn K., Kollée L. A. Foregoing intensive care treatment in newborn infants with extremely poor prognoses. A study in four neonatal intensive care units in The Netherlands. J Pediatr. 1996 Nov;129(5):661–666. doi: 10.1016/s0022-3476(96)70146-4. [DOI] [PubMed] [Google Scholar]
  10. de Wachter M. A. Euthanasia in The Netherlands. Hastings Cent Rep. 1992 Mar-Apr;22(2):23–30. [PubMed] [Google Scholar]
  11. van der Heide A., van der Maas P. J., van der Wal G., Kollée L. A., de Leeuw R., Holl R. A. The role of parents in end-of-life decisions in neonatology: physicians' views and practices. Pediatrics. 1998 Mar;101(3 Pt 1):413–418. doi: 10.1542/peds.101.3.413. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. van der Wal G., van der Maas P. J., Bosma J. M., Onwuteaka-Philipsen B. D., Willems D. L., Haverkate I., Kostense P. J. Evaluation of the notification procedure for physician-assisted death in the Netherlands. N Engl J Med. 1996 Nov 28;335(22):1706–1711. doi: 10.1056/NEJM199611283352228. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES