【体外膜肺ECMO精品课件】 End-of-Life Care on the NICU.ppt

Ethical Dilemmas in the NICU Is withdrawal of support tantamount to “murder,” no matter how dismal the prognosis for recovery? Would an inability to withdraw support lead to withholding of potentially successful NICU therapy for fear of a protracted burden of failure for some? Neonatal End-of-Life Palliative Care Protocol — Inpatient-Outpatient Provide support for a peaceful, pain-free and family-centered death for dying newborns Provide mind, body and spiritual care for an infant who is not going to get better with focus on the infant and family Prevent and relieve infant’s physical pain and suffering and improve the condition of the infant’s living and dying including management of such symptoms as pain, airway hunger, skin, dry lips/mouth and seizures Caitlin A, Carter B. Committee of information from 101 member panel, 16 published protocols. J Perinatol 22:184, 2002 Leenay M. Department of Family Medicine and Community Health, University of Minnesota Medical School and Fairview-University Medical Center The Groningen Protocol for Euthanasia in Newborns Requirements that must be fulfilled Diagnosis and prognosis must be certain Hopeless and unbearable suffering must be present Must confirm diagnosis, prognosis and unbearable suffering with at least one other independent physician Both parents must give informed consent Procedure must be performed in accordance with the accepted medical standard Verhagen E, Sauer PJJ. NEJM 352:959, 2005 Prenatal Decision to Forego Resuscitation in the Delivery Room Neonatologists’ (n=149) Parental Wishes Assessment of Options Prefer Care Forego Care Beneficial Not asked Provide-91% Uncertain Provide Care-100% Forego-76% Futile Provide care-33% Not asked Note: 22% of neonatologists have withheld resuscitation at least once in past five years when parents have requested it From Peerzada JM, et al. J Pediatr 145:492, 2004 Quality of Palliative Care —Painful Isolated Incidents One of the most s