Thirty years of evolution of neonatal reanimation end of life care in France: A palliatologist's point of view

By evolving since the 1980s, modern neonatology significantly reduced the morbidity and mortality of pre-term newborns. This evolution exposes new questioning situations by saving life but with sometimes heavy sequels. The neonatologists' medical practices evolved from ``end of life decision-making'' to accompaniment of the patient and his family in a palliative care perspective. This evolution was impacted by multiple recommendations from the French national consultative ethics committee (No. 63, 65 and 121) that spoked firstly of ``euthanasia exception'' and later of grave transgression. The committee was influenced by the results from two studies, EPIPAGE 1 and 2, which showed an amelioration of morbidity and mortality of pre-term newborns, for all terms on the last decades. This evolution was also due to new laws in France: first in 2002 relative to patients' rights and the quality of healthcare system, then in 2005 relative to patients' rights and the end of life. However, some difficult situations persist, particularly when withdrawing artificial nutrition and hydration. The body of a child dying of undernutrition seems to be an unbearable sight for caregivers and families. Some authors legitimate a systematic ``terminal sedation'' together with the withdrawal of nutrition and hydration to ``limit suffering''. Others speak of ``fixing a reanimation mistake'' for children alive thanks to reanimation. They think they can ``undo'' things and by this way they differentiate a ``natural'' life and an ``artificial'' life. All of this prompts us to conduct a study to understand the argumentation of end of life decision in neonatal reanimation. (C) 2019 Elsevier Masson SAS. All rights reserved.