Practical implementation of the collegial decision-making procedure in case of possible unreasonable obstinacy in Neonatology

Abstract

Introduction: The withholding or withdrawal of life-sustaining treatment has become the predominant cause of death in neonatal intensive care units. The advancements in perinatal medicine have led to a re-evaluation of the necessity and relevance of initiating and maintaining those treatments in patients whose conditions are not expected to improve. This decision must be made in accordance with the codified collegial decision-making process outlined in French law. In light of the shifts in end-of-life care, a review of professional practice is crucial.

Objective: The objective of this study was to analyze the practical implementation of the collegial decision-making process in the Neonatology Department of the Caen University Hospital. The analysis focused on three key areas: the logistical setup, the compliance with the legal framework, and the deliberation mechanisms for each collegial decision-making process. To assess the implementation of the limitation of life-sustaining treatment meetings, a variety of methods were employed, including participant observation, review of medical records, and the distribution of surveys to participants.

Results: In one year, 16 collegial decision-making processes were initiated, and 20 meetings were scheduled to discuss the restrictions on life-sustaining treatment. In 2 cases, the process was initiated by parents. The primary clinical condition that prompted the implementation of a collegial procedure was neurological. The presence of an external consultant was noted in 19 times. In 3 out of 20 times, parents weren't notified of their child's meeting prior to the date but all were informed of the meeting's conclusions. Data indicate a statistically significant correlation between professional category and perceived freedom to speak and legitimacy to do so, and the influence of the legal guardian's viewpoint on the participants' thinking.

Conclusion: The legal framework was generally respected, and the culture of service facilitated the incorporation of the collegial procedure into the habits of professionals.

Keywords: Leonetti law; NICU; end-of-life; ethics; life-sustaining treatment; palliative care; therapeutic obstinacy; unreasonable obstinacy.