• Astrid M Vrakking, Agnes van der Heide, Veerle Provoost, Johan Bilsen, Gerrit van der Wal, and Luc Deliens.
• Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. a.vrakking@erasmusmc.nl
• Acta Paediatr. 2007 Jun 1;96(6):820-4.

AimWe compared the results of two recent studies on end-of-life decisions (ELDs) for neonates and infants in Belgium (Flanders) and The Netherlands.MethodsQuestionnaires were sent to physicians who reported the death of a child under the age of 1 (Belgium: n = 292, response 87%; Netherlands: n = 249, response 84%). The questionnaires included structured questions about whether death had been preceded by ELDs, and about the decision-making process.ResultsIn both countries, in about 25% of all deaths a life-sustaining treatment was withheld, and in about 40% pain or other symptoms were alleviated taking into account that death might be hastened. In Belgium, a life-sustaining treatment was less often withdrawn than in The Netherlands (32% vs. 50%, respectively). Drugs were administered with the explicit intention of hastening death in similar percentages of all deaths (Belgium: 7%; Netherlands: 9%). Dutch physicians more often than Belgian physicians discussed ELDs with parents (96% vs. 81%, respectively), and with colleague physicians (94% vs. 80%, respectively).ConclusionsEnd-of-life decision making in severely ill neonates seems to be rather similar in Belgium and The Netherlands. Differences are that Dutch physicians more often withdraw life-sustaining treatment. Furthermore, parents and colleague physicians are more often involved in the decision making in The Netherlands.

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