J Korean Med Sci.  2024 Jul;39(25):e196. 10.3346/jkms.2024.39.e196.

Beyond Legal Boundaries: Public and Clinician Perspectives on Treatment Withdrawal in Infants With Poor Neurological Prognosis

• Song IG
• Lee J
• Kim MS
• Lee JW
• Jeon SY
• Yoo SH
• Park HY

• KMID: 2557771
• DOI: http://doi.org/10.3346/jkms.2024.39.e196

Abstract

Background
Despite medical advancements in neonatal survival rates, many children have poor neurological outcomes. Because the law in Korea restricts the withdrawal of lifesustaining treatment to only cases of imminent death, treatment discontinuation may not be an option, even in patients with poor neurological prognosis. This study investigated the opinions of the general population and clinicians regarding life-sustaining treatment withdrawal in such cases using hypothetical scenarios.
Methods
We conducted a cross-sectional study on the general population and clinicians using a web-based questionnaire. The sample of the general population from an online panel comprised 500 individuals aged 20–69 years selected by quota sampling. The clinician sample comprised 200 clinicians from a tertiary university hospital. We created hypothetical vignettes and questionnaire items to assess attitudes regarding mechanical ventilation withdrawal for an infant at risk of poor neurological prognosis due to birth asphyxia at 2 months and 3 years after the incidence.
Results
Overall, 73% of the general population and 74% of clinicians had positive attitudes toward mechanical ventilator withdrawal at 2 months after birth asphyxia. The proportion of positive attitudes toward mechanical ventilator withdrawal was increased in the general population (84%, P < 0.001) and clinicians (80.5%, P = 0.02) at 3 years after birth asphyxia. Religion, spirituality, the presence of a person with a disability in the household, and household income were associated with the attitudes of the general population. In the multivariable logistic regression analysis of the general population, respondents living with a person with a disability or having a disability were more likely to find the withdrawal of the ventilator at 2 months and 3 years after birth asphyxia not permissible. Regarding religion, respondents who identified as Christians were more likely to find the ventilator withdrawal at 2 months after birth asphyxia unacceptable.
Conclusion
The general population and clinicians shared the perspective that the decision to withdraw life-sustaining treatment in infants with a poor neurological prognosis should be considered before the end of life. A societal discussion about making decisions centered around the best interest of pediatric patients is warranted.

Keyword

Public Opinion; Clinician’s Opinion; Hypoxia-Ischemia; Brain; Infant; Life-Sustaining Treatment Withdrawal

Figure

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  Fig. 1 Attitudes toward mechanical ventilator withdrawal at 2 months and 3 years after birth asphyxia stratified by the general population and clinicians. P values in the figure were derived from McNemar’s test.

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  Fig. 2 Reasons for the response for mechanical ventilator withdrawal at 2 months after birth asphyxia stratified by the general population and clinicians.

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