The ethics of withholding/withdrawing nutrition in the newborn☆
Section snippets
Ethical considerations of withdrawing artificially administered nutrition and hydration in adults
Ethical considerations around the provision or withholding of nutrition gained attention in medical practice in the late 1970s and early 1980s. An “emerging stream” of thought that fluids and nutrition could be withheld became apparent, argued around 2 propositions:
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The medical administration of nutrition is a medical intervention, and
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A benefits/burdens calculation was the critical element of judgment about withholding/withdrawing medical interventions (the rule of proportionality).
In an early
Pediatric withdrawal of artificially administered nutrition
The support found in the adult literature that withholding artificially administered nutrition near the end-of-life does not prolong life, may not be true in pediatrics. Certainly, there are pediatric patient populations for whom gastrostomy tube feedings or parenteral nutrition will prolong the life of the child. This may be so, even if the child will ultimately die from their underlying condition. A ready example would be the premature infant with an extremely short gut - perhaps following
Practical strategies in the NICU
Given the occasional necessity to consider the WH/WD of artificially administered nutrition in the NICU, what guidance can be given?
First and foremost, the necessity of maintaining communication between the parents, extended family, and the health care staff must be underscored. All involved should be aware of the infant’s signs and symptoms that may develop with the withdrawal of artificial hydration and nutrition, the time frame over which these will likely appear following withdrawal, and a
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Cited by (56)
The logistics of withdrawing life-sustaining medical treatment in the neonatal intensive care unit
2023, Seminars in Fetal and Neonatal MedicineWithdrawing and Withholding Life-Sustaining Medical Therapies in the Neonatal Intensive Care Unit: Case-Based Approaches to Clinical Controversies
2022, Clinics in PerinatologyCitation Excerpt :Medical interventions for pediatric patients are ethically optional if they do not meet typical goals of growth and development, follow parent-specific goals of care, cause significant pain with little pleasure, or lengthen the dying process.5 Infants are unable to express preferences, so the best interest standard (BIS) guides the medical team and parents in shared decision-making when considering WWLSMT.5,6 Benefits of treatment are weighed against burdens.
Characterization of Death in Infants With Neonatal Seizures
2020, Pediatric NeurologyCitation Excerpt :A small number of infants died after a decision to withhold or withdraw artificial hydration and/or nutrition; all three of these infants were from a single institution and were transferred to hospice. Withholding or withdrawing artificial nutrition and hydration in the newborn period is controversial.16-19 Professional guidelines suggest that this practice is acceptable in select circumstances, including instances in which the child “permanently lacks awareness and the ability to interact with the environment” and when the provision of fluids and nutrition serves solely to “prolong and add morbidity to the process of dying.”20
Palliative care after neonatal intensive care: Contributions of Leonetti Law and remaining challenges
2017, Archives de PediatrieOne Facility's Experience in Reframing Nonfeeding into a Comprehensive Palliative Care Model
2013, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
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This work was completed at Vanderbilt University Medical Center in Nashville, TN. B. S. C. is supported in part by a grant from the Initiative for Pediatric Palliative Care, Center for Applied Ethics & Professional Practice, Education Development Center, Inc, Newton, MA.