In these situations I will usually go to the parents and apprise them of the situation. We can continue ventilating the baby full bore, until his heart finally gives out in several hours, or we can stop the ventilator and let the parents hold him, often in a private room. Death comes more quickly then. I usually recommend stopping life support, and speak about letting him die with dignity. Sometimes parents will do that, but other times they cannot bear to give permission to stop the ventilator.
Now, I truly believe it is better to just stop the ventilator in these cases, and that continuing to pound the lungs with the ventilator until the bitter end does no one much good. And I do believe in death with dignity, and that it is better for the parents to be able to hold their baby and simply be a family, even if it is for a short time. But the real reason I want to stop the ventilator is so the baby will die more quickly and I can get some sleep.
I'm pretty sure it sounds petty or selfish of me to be thinking of a few extra hours of sleep, when a baby is dying and a family undergoing a life changing event. But I can't help it. I spend about six nights a month on call in the hospital, and if I'm up all night I'm tired for days afterwards. If I can get some sleep when I'm on call it's not so bad, and it seems really annoying to miss sleep when you know you're just continuing to ventilate a baby everyone knows will die anyway. It's not that I have ill will towards the parents or anything. I just get tired of being tired.
Sometimes I think the best solution would be for neonatologists to be able to stop the ventilator in these situations without the parents' permission. It would avoid making the parents feel guilty about turning off their baby's life support; it would let the baby die with at least a small modicum of dignity; and it would let me get my sleep. It sounds like a win-win situation to me, but I don't think it's going to happen in this country.
P.S. My apologies for not posting a post on Saturday. I was out of town for the holiday weekend, and the wireless hot spot I thought I could use wasn't working.