Insight into end-of-life decisions in newborns in Flanders, Belgium

In the Netherlands, as in many other European countries, the majority of deaths in newborns are preceded by end-of-life decisions. In most cases, these decisions concern the withholding or withdrawing of treatment. Drugs with a potential life-shortening effect are often prescribed in the terminal phase of treatment of newborns to alleviate their suffering. The use of lethal drugs in order to deliberately end the life of newborns with a very poor prognosis and intractable severe suffering has been reported by Dutch paediatricians. Recently published data about end-of-life decisions in newborns in Flanders have shown that paediatricians in Flanders also consider the deliberate ending of life in newborns and young infants to be an acceptable option in exceptional circumstances. Real insight into the existing practice remains limited because the deliberate ending of life legally qualifies as murder in both countries. Few cases are reported because of the physician's fear of prosecution. Physicians in Flanders and in the Netherlands have pleaded for a different system of control of the deliberate ending of life in newborns. The Dutch government has recently announced the instalment of a multidisciplinary committee of experts to whom all cases must be reported. The advice of the committee to the prosecuting authorities will be crucial. It is expected that this change will increase the willingness to report cases.