2015, Number 6
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salud publica mex 2015; 57 (6)
End-of-life decisions in perinatal care. A view from health-care providers in Mexico
Grether P, Lisker R, Loria A, Álvarez-del-Río A
Language: English
References: 23
Page: 489-495
PDF size: 257.73 Kb.
ABSTRACT
Objective. To examine the opinions of a perinatal health
team regarding decisions related to late termination of pregnancy
and severely ill newborns.
Materials and Methods.
An anonymous questionnaire was administered to physicians,
social workers, and nurses in perinatal care. Differences were
evaluated using the chi square and Student’s t tests.
Results.
When considering severely ill fetuses and newborns, 82%
and 93% of participants, respectively, opted for providing
palliative care, whereas 18% considered feticide as an alternative.
Those who opted for palliative care aimed to diminish
suffering and those who opted for intensive care intended
to protect life or sanctity of life. There was poor knowledge
about the laws that regulate these decisions.
Conclusions.
Although there is no consensus on what decisions should be
taken with severely ill fetuses or neonates, most participants
considered palliative care as the first option, but feticide or
induced neonatal death was not ruled out.
REFERENCES
Darmstadt GL. Global Perinatal Health Accelerating Progress Through Innovations, Interactions, and Interconnections. Semin Perinatol 2010;34(6):367-370.
Critical care decisions in fetal and neonatal medicine: ethical issues. Nuffield Council on Bioethics; November 2006; London. Available at: http://nuffieldbioethics.org/wp-content/uploads/2014/07/CCD-webversion- 22-June-07-updated.pdf
Kilby MD, Pretlove SJ, Russell ARB. Multidisciplinary palliative care in unborn and newborn babies Coordinated clinical care and psychological, spiritual, and social support must be provided throughout the process. B M J 2011;342:d1808.
Royal College of Obstetricians and Gynecologists. Termination of Pregnancy for fetal abnormality in England, Scotland and Wales. May 2010. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/ terminationpregnancyreport18may2010.pdf
Royal Dutch Medical Association. Clear criteria for medical end of life decisions for newborn infants with very serious birth defects. Available at: http://www.nvk.nl/Nieuws/Dossiers/Levensbeeindigingbijpasgeborenen.aspx
Carnevale A, Lisker R, Villa Ar, Casanueva E, Alonso E. Counselling following diagnosis of a fetal abnormality: comparison of different clinical specialists in Mexico. Am J Med Genet 1997:3;69(1):23-28.
Casanueva E, Lisker R, Carnevale A, Alonso E. Attitudes of Mexican physicians toward induced abortion. Int J Gynaecol Obstet 1997;56(I):47.52
Lisker R, Alvarez del Rio A, Villa AR, Carnevale A. Physician-assisted death. Opinions of a sample of Mexican physicians. Arch Med Res 2008;39(4):452-458.
Loria A, Villareal-Garza C, Sifuentes E, Lisker R. Physician-assisted Death. Opinions of Mexican Medical Students and Residents. Arch Med Res 2013:44:475-478.
Garduño-Espinosa A, Mancilla OH, Venegas JM, Zúñiga MN, De Pando Cerda JM, Benavides RM, et al. Decisiones médicas al final de la vida. Recomendaciones para la atención a pacientes con enfermedades en estado terminal. (Spanish). Acta Pediatrica de Mexico 2006;27(5):307-316.
Verhagen AAE, Sauer PJJ. End-of-life decisions in newborns: An approach from the Netherlands. Pediatrics 2005;116(3):736-739.
Paintin D. Abortion after 24 weeks. Br J Obstet Glynaecol 1997;104(4):398-400.
Dobscha SK, Heintz RT, Press N, Ganzini L. Oregon physicians’ responses to requests for assisted suicide: a qualitative study. J Palliat Med 2004;7(3):451-461.
Materstvedt LJ, Kaasa S. Euthanasia and physician-assisted suicide in Scandinavia-with a conceptual suggestion regarding international research in relation to the phenomena. Palliat Med 2002;16(1):17-32.
Alvarez Del Rio A, Luisa Marvan M. On euthanasia: exploring psychological meaning and attitudes in a sample of Mexican physicians and medical students. Develop World Bioeth 2011;11(3):146-153.
Engelhardt HT. La eutanasia en niños de corta edad: Cuestiones éticas. In R Baird, S Rosembaum. Eutanasia: Los dilemas morales. Barcelona: Ediciones Martínez Roca, 1992:154-165.
Raspall F, Royes A. Declaration on the limits to therapeutic efforts in neonatal care units Barcelona. Signo Impressió Gràfica. [consulted 2013 October] Available in:http://www.pcb.ub.edu/bioeticaidret/index. php?option=com_content&task=view&id=373&Itemid=41〈=en_UK 2009
Bellieni CV, Buonocore G. Flaws in the assessment of the best interests of the newborn. Acta Paediatrica 2009;98(4):613-617.
Schuklenk U. Physicians can justifiably euthanize certain severely impaired neonates. J Thorac Cardiovasc Surg 2015;149(2):535-537.
Dworkin R. Life´s Dominion. An argument about abortion, euthanasia and individual freedom. New York: Books V, 1994:69-101.
Janvier A, Leblanc I, Barrington KJ. The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrics 2008;121(5):963-969.
Callahan D, Meilaender G, Smith W, Lysaught M, Whitbeck C, May W, et al. The sanctity of life seduced: A symposium on medical ethics. First Things 1994;42:13-27.
Heuser CC, Eller AG, Byrne JL. Survey of physicians’ approach to severe fetal anomalies. J Med Ethic 2012;38(7):391-395.