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American Journal of Critical Care. 2009;18: 160-168 doi:10.4037/ajcc2009515
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

By Els Inghelbrecht, MA, Johan Bilsen, PhD, Heidi Pereth, MSc, José Ramet, PhD and Luc Deliens, PhD. Els Inghelbrecht is a doctoral student in the End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.Johan Bilsenis a professor in the End-of-Life Care Research Group and in the Department of Public Health, Vrije Universiteit Brussel, and in the Bioethics Institute Ghent, Ghent University, Belgium.Heidi Perethis a nurse in the pediatric intensive care unit at University Hospital Brussels, Belgium.José Rametis a professor in the Department of Pediatrics at Antwerp University Hospital, University of Antwerp, Belgium. Luc Deliensis a professor in the End-of-Life Care Research Group, Vrije Universiteit Brussel, and in the Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.

Corresponding author: Els Inghelbrecht, Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium (e-mail: Els.Inghelbrecht{at}vub.ac.be).

Objective To investigate Belgian pediatric intensive care nurses’ involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect.

Methods Questionnaires were distributed to 141 nurses working in 5 of the 7 pediatric intensive care units in Belgium. Nurses were asked to recall the last child in their care whose treatment involved an end-of-life decision and to describe anonymously their involvement in the decision. Attitudes were ascertained by means of statements and a Likert scale.

Results Questionnaires were completed by 89 nurses (63%). During the preceding 2 years, 76 (85%) had cared for at least 1 child for whom a medical end-of-life decision had been made. Nurses were involved in initiating the decision in 17% of cases, participated in decision making in 50%, and played a role in carrying out the decision in 90%. Only 6% of nurses found it always ethically wrong to hasten the death of a child by administering lethal drugs; most nurses (78%) reported they were prepared to cooperate in administering life-ending drugs in some cases. Most (89%) favored adapting the law, making life termination of children legally possible in certain cases.

Conclusions Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.






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Copyright © 2009 by the American Association of Critical-Care Nurses.