ABSTRACT
OBJECTIVE: To study the willingness of Dutch physicians to use potentially life-shortening or lethal drugs for severely ill children. STUDY DESIGN: We asked 63 pediatricians about their approach to 10 hypothetical cases of children with cancer. The age of the child (15, 11, or 6 years), the child's (explicit) request, and the opinion of the parents varied. Two hypothetical cases were also presented to 125 general practitioners and 208 clinical specialists. RESULTS: Most pediatricians were willing to increase morphine in all cases. A total of 48% to 60% of pediatricians were willing to use lethal drugs in children at the child's request, when the parents agreed; when parents requested ending of life of their unconscious child, 37% to 42% of pediatricians were willing; 13% to 28% of pediatricians were willing when parents did not agree with their child's request. General practitioners and clinical specialists were as willing as pediatricians to use lethal drugs at the child's request, but less willing to grant a request of parents for their unconscious child. CONCLUSIONS: Many Dutch pediatricians are willing to use potentially life-shortening or lethal drugs for children. The legal limit of 12 years, as the age under which voluntary euthanasia is forbidden, is not fully supported by Dutch physicians.
Subject(s)
Attitude of Health Personnel , Euthanasia/psychology , Morphine/administration & dosage , Neoplasms/psychology , Parents/psychology , Pediatrics , Adolescent , Adult , Child , Euthanasia/legislation & jurisprudence , Female , Humans , Male , Middle Aged , Neoplasms/classification , Netherlands , Severity of Illness IndexABSTRACT
The South Asians in The Netherlands have a high diabetes prevalence in combination with a low socio-economic position. A new, culture-specific type of care was developed. This intervention study investigates which patient characteristics are associated with success and whether those in the lowest socio-economic position have been reached. Before and after the end of the intensive guidance, the HbAlc of the patients (n=101) was measured. The following variables were significantly related to success (defined as a decrease in HbAlc > or = 0.8%): a high initial HbAlc, a low BMI and presence of complications. The average improvement in HbAlc was significant only in the group with a higher socio-economic position. Although the patients with the lowest socio-economic position did not sufficiently benefit from this intervention, an overall improvement was achieved in this poorly educated study population. The further improvements in the care after the completion of this study should be evaluated.