Stavovi neonatologa vezani uz odluke o završetku života pedijatrijskih pacijenata

Advances in medicine and technology over the past few decades have led to a significant increase in survival of critically ill and/or extremely preterm neonates. Unfortunately, in some cases, intensive care interventions cannot cure the patient but only prolong the process of dying. In some patients, severe illness and prematurity leaves permanent consequences that can significantly impair their quality of life. This raises a number of ethical questions and dilemmas, and it is increasingly questioned whether human life should be saved at all costs. The objectives of this study are to examine the attitudes of neonatologists in Croatia regarding end of life decisions/forgoing treatment in pediatrics and to compare the attitudes of physicians in Croatia with the attitudes of physicians in other European countries and the United States. The study involved 60 pediatricians employed at neonatology departments in Croatia (approximately two-thirds of the total population of physicians employed at neonatology departments ih Croatia). In the study, we used a modified version of the questionnaire developed for the EURONIC Project on “Parents' information and ethical decision-making in neonatal intensive care units: staff attitudes and opinions” (Cuttini et al., 1996). We have found that, consistent with the results of other studies conducted in Europe and North America, majority of physicians consider the decision to forgo treatment ethically justified when the patient's condition is fatal and when a significantly impaired quality of life is expected upon survival. Most physicians believe that the decision to continue or forgo treatment should be made together with the child's parents, but point out the difficulties in communicating with parents as a factor that complicates this process. When a decision to forgo treatment is made, physicians are more likely to passively withold treatment compared to its active withdrawal. Euthanasia is unacceptable to a majority of physicians. In the context of Croatia, the results of this research emphasize the need for the development of professional guidelines related to forgoing treatment in neonatology and suggest the liberalization of the law in a way that allows witholding/withdrawal of treatment in a greater extent.