Relationship Of Neonatologists' End Of Life Decisions To Their Personal Fear Of Death

Doctors who fear their own death say they are more prepared than other doctors to hasten death in sick newborns for whom further medical treatment is considered futile, reveals research published ahead of print in the Fetal & Neonatal Edition of Archives of Disease in Childhood.

The findings are based on an anonymous survey of 138 doctors specialising in the care of sick newborns (neonatologists) across Australia and New Zealand.

The doctors were asked questions about their ethical practice and to complete the Multidimensional Fear of Death Scale (MFODS), which measures different facets of personal fear of death.

Of the 138 doctors contacted, 78 (56%) completed the questionnaire. Virtually all of them said they sometimes withheld or withdrew life-sustaining treatment in newborns with severe mental and/or physical disability and those for whom further medical treatment was considered to be "overly burdensome" or futile.

They said they used painkillers or sedatives in both situations to alleviate pain and suffering, but without intending to hasten death.

But one in three specialists was prepared to use painkillers or sedatives to relieve pain and suffering by intentionally hastening death in newborns with severe disability.

And more than three out of four were prepared to hasten death for this purpose in babies for whom further treatment was considered futile.

In this situation, they preferred to use painkillers or sedatives to hasten death rather than withhold minimal treatment, such as tube feeds or oxygen, in a bid to prevent unnecessary pain and suffering.

But one in five neonatologists said that hastening death in this context was unacceptable by either means.

There was a link between the neonatologists' personal fear of death and their ethical practice.

Doctors who said they were not prepared to hasten death had significantly less fear of the "dying process" and of "premature death" than those prepared to hasten death with painkillers or sedatives. But they had significantly more "fear of being destroyed."

The author suggests that doctors' fear of the dying process or of premature death may unconsciously motivate them to hasten a newborn's death in order to relieve their own death anxiety.

Similarly, those who fear being "destroyed" may not be prepared to hasten death, because of their own fears, even though this may be the most humane way to relieve a newborn's suffering.

In an accompanying editorial, Martin Ward Platt points out that the findings should not be interpreted as indicative of rampant euthanasia on neonatal units.

Rather, he says, the study shows that "In relation to neonatal death and dying, doctors' fear, or lack of it, matters. It matters because it can influence clinical judgements."

He adds: "Recognising this difference is an important aspect of self knowledge, and there is a case to be made for all of us to be more open about it."

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Contact: Emma Dickinson
BMJ Specialty Journals