How it feels to withdraw feeding from newborn babies

And what about neonatal palliative care?

14 November 2012

A recent BMJ article [1] has awakened me to the fact that the practice of withdrawing nutrition and hydration from severely handicapped newborns is accepted in civilized countries. It ineluctably leads to a prolonged agony for the babies, and a mental agony for the parents and treating pediatric team. Luckily for babies, parents and medical staff, such ethically controversial practices are not permitted in most countries of the world.

When caring for newborns with mental or physical impairments, there is another alternative than the direct euthanasia by terminal sedation proposed by Dr David Bihari.[2] Imposing death to an infant that cannot give consent is not the sole way of relieving discomfort and pain. A more humane option is offered by pediatric palliative care, or rather neonatal palliative care in this case. Neonatal palliative care is a holistic approach to the physical, emotional, spiritual and social suffering of babies suffering from life-threatening diseases and of their families.

Neonatal euthanasia first appeared in the Netherlands, in the hope of offering an easy way out for newborns with “hopeless and unbearable suffering”. Soon after the Groningen Protocol proposed "active ending of life on infants" at the parents’ decision,[4] the Dutch Society for Pediatrics made this protocol mandatory for Pediatricians in 2005. It would be interesting to know how many pediatricians would like to contest such decision, in the name of conscientious objection, especially if they were trained in palliative care. Just try to learn about the palliative care approach, and you will rather opt for it, enabling the baby to live fully and comfortably until death.

1. Anonymous. How it feels to withdraw feeding from newborn babies. BMJ 2012;345:e7319
2. David Bihari. Rapid response to “How it feels to withdraw feeding from newborn babies”.
3. Catlin A, Carter B. Creation of a neonatal end-of-life palliative care protocol. J Perinatol 2002;22(3):184-95.
4. Verhagen E, Sauer PJ. The Groningen protocol-euthanasia in severely ill newborns. N Engl J Med 2005;352(10):959-62.

Competing interests: None declared

Veronique Dinand, Pediatric Oncologist

Sir Ganga Ram Hospital, Rajender Nagar, New Delhi 110060

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