Withholding and withdrawing neonatal intensive care☆

Abstract 

Decisions relating to the withholding, limiting or withdrawal of intensive care support are a necessary part of a neonatal unit's practice.

Health professionals and parents have a duty to act in partnership in the infant's best interests. Clinical guidelines and the law help define circumstances when it is ethically and legally acceptable to consider withholding or withdrawing treatment. Good practice dictates that a consensus should be achieved both between unit staff themselves and with parents. Senior staff involvement and effective, timely communication is essential to achieve this and only rarely will the law need to be involved. An honest, consistent approach is essential and discussions must be carefully documented. Parents need to be provided with sufficient information in a way that they can understand and assimilate, and most parents wish to be involved in both the decision-making and the dying process; ways of achieving this are discussed.

Follow-up is important. Primary healthcare professionals need to be involved early in the process and contact should be established by someone from the unit well known to the parents within 2 months of the death of their child.

Keywords: neonatal intensive care, ethics, withdrawal of care

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