Aim. To provide an empirical background for the ethical discussion on the parents' versus the physician's role, when difficult decisions concerning the end of life in newborn infants have to be made.

Subjects. Face-to-face interviews were conducted with a stratified sample of 66 pediatricians. The response rate was 99%.

Measurements. The most recent decisions in newborn infants to hasten death or not prolong life and the most recent cases in which such decisions were not made because either the parents or the physician objected were comprehensively discussed.

Results. Decisions to hasten death or not prolong life were usually made after discussing it with parents, and did not occur while parents were known to disagree. Situations in which an end-of-life decision was not made because parents did not consent predominantly involved infants with complications of prematurity (24%) or perinatal asphyxia (40%), whereas situations in which parents requested an end-of-life decision that was not acceded to by the pediatrician involved Down syndrome as the main diagnosis in 43%, and as a concurrent diagnosis in 21%. Pediatricians afterwards often expressed feelings of discontent about situations in which there had been disagreement with parents.

Conclusion. The opinion of parents about which medical decision is in the best interest of their child is very important for pediatricians, but only decisive in case it invokes the continuation of treatment.
Pediatric Research: international journal of human developmental biology

van der Heide, A., van der Maas, P., van der Wal, G., Kollee, L. A., de Leeuw, R., & Holl, R. A. (1998). Physicians' attitudes towards parents in end-of-life decisions in neonatology. Pediatric Research: international journal of human developmental biology, 44(3). Retrieved from