Relation of neonatologists' end-of-life decisions to their personal fear of death

Abstract

Objective: To study the relationship of Australian and New Zealand (ANZ) neonatologists’ personal fear of death to their forgoing life sustaining treatment and hastening death in newborns destined for severe disability and newborns for whom further treatment is considered non-beneficial or overly burdensome.

Design: A self-report questionnaire survey of ANZ neonatologists.

Setting: Neonatologists registered in the 2004 ANZ Directory of Neonatal Intensive Care Units. Participants The 78 (56%) of 138 neonatologists who responded to the study questionnaire.

Main outcome measures: Between group differences in the Multidimensional Fear of Death Scale.

Results: In newborns for whom further treatment was deemed futile, 73 neonatologists reported their attitude to hastening death as follows: 23 preferred to hasten death by withdrawing minimal treatment, 35 preferred to hasten death with analgesia-sedation, and 15 reported hastening death was unacceptable. Analysis of variance showed a statistically significant difference between the three groups concerning Fear of the Dying Process (F = 3.78, P = .028), Fear of Premature Death (F = 3.28, P = .044) and Fear of Being Destroyed (F = 3.20, P = .047). Post-hoc comparisons showed that neonatologists who reported hastening death was unacceptable compared with neonatologists who preferred to hasten death with analgesia-sedation had significantly less Fear of the Dying Process and Fear of Premature Death and significantly more Fear of Being Destroyed.

Conclusions: ANZ neonatologists’ personal fear of death and their attitude to hastening death when further treatment is considered futile are significantly related. Neonatologists’ fear of death may influence their end-of-life decisions.