End-of-Life Decisions for Children: Empirical Studies on Physicians’ Practices and Attitudes

This thesis describes the practice of end-of-life decision-making in neonates and older children, the attitudes of paediatricians and other physicians towards physician-assisted dying and their opinion about the Euthanasia Act. The following research questions are formulated: 1. How often are end-of-life decisions made and what are the characteristics of end-of-life decision-making in neonates and infants? 2. How did the Dutch practice develop over time, and is it different from Belgium? 3. How often are end-of-life decisions made in older children and what are the characteristics of the decision-making process? 4. What are the attitudes of paediatricians and other physicians towards assisted death in children and what are their opinions about the Euthanasia Act? The first conclusion is that the practice of end-of-life decision-making in neonates seems stable. The frequency of end-of-life decisions has not risen significantly and decisions are in the large majority discussed with parents and physicians. Further, the practice is virtually similar to the Belgian practice. The frequency of end-of-life decisions for older children is lower than the frequency among deceased infants and is slightly lower than the frequency among adults. Decision-making takes place with parents, colleague-physicians and nurses in the majority of cases. About half of all physicians supported the Euthanasia Act and thinks it can contribute to the transparency and carefulness of the decision-making.

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