Cambridge Quarterly of Healthcare Ethics

Special Section: From Cells to Selves: Ethics at the Beginning of Life

Acting or Letting Go: Medical Decision Making in Neonatology in The Netherlands

E. van Leeuwena1 and G. K. Kimsmaa2

a1 University of Amsterdam

a2 University of Amsterdam

The development of neonatology and the establishment of neonatal intensive care units has led to a vast array of new medical ethical problems and dilemmas centered around discontinuing treatment or nontreatment decisions. Neonatology has become one of the fields that has made clear that medical success is only rarely nonproblematic. The new technology can be a blessing for some, but it may also become a sad experience to others, with life-long repercussions.

The ethical problems of neonatology transcend national boundaries. Nevertheless, there are differences in approach among various countries. In The Netherlands, the ethical deliberations have been a matter of public debate, but most of the decision making is left to the medical profession; these decisions are considered too harsh for the general public. Recently, two developments have emerged. The Royal Dutch Medical Association (RDMA) and the Dutch Pediatrics Society have published reports with guidelines and ethical reflections. Over the same period of time, cases have been brought to court for legal analysis and the development of case precedence.