Ethics in neonatology: a look over Europe

J Matern Fetal Neonatal Med. 2012 Jul;25(7):984-91. doi: 10.3109/14767058.2011.602442. Epub 2011 Aug 30.


Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge, the ethical issues are controversial and little evidence exists on attitudes and values in Europe.

Objective: to assess the attitudes of the neonatal departments in perinatal clinical practice in the hospitals of European countries.

Methods: a questionnaire was send to 55 NICUs from 19 European countries.

Results: Forty five (81.8%) NICUs were Level III. Religion was Christian in 90.7% and we observed that in north countries the religion is more influent on clinical decisions (p = 0.032). Gestational age was considered with no significant difference for clinical investment. North countries consider birth weight (p = 0.011) and birth weight plus gestational age (p = 0.024) important for clinical investment. In north countries ethical questions should not prevail when the decision is made (p = 0.049) and from an ethical point of view, there is no difference between withdraw a treatment and do not initiate the treatment (p = 0.029). More hospitals in south countries administer any analgesia (p = 0.007). When the resuscitation is not successful 96.2% provide comfort care.

Conclusion: Our study reveals that cultural and religious differences influenced ethical attitudes in NICUs of the European countries.

MeSH terms

  • Europe
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal / ethics*
  • Intensive Care Units, Neonatal / standards
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Intensive Care, Neonatal / ethics*
  • Intensive Care, Neonatal / standards
  • Neonatology / ethics*
  • Resuscitation / standards*