Letters Neonatal end of life care

GMC guidance on neonatal palliative care

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8000 (Published 26 November 2012) Cite this as: BMJ 2012;345:e8000
  1. Laura de Rooy, consultant neonatologist1
  1. 1St George’s Hospital NHS Trust, London SW17 0QT, UK
  1. Laura.Derooy{at}stgeorges.nhs.uk

The Personal view “How it feels to withdraw feeding from newborn babies” was poignant but does not represent current practice in the UK and is not aligned with current UK guidance.1 2 3 4

The article references the American guidance, which suggests that it may be ethically appropriate to withdraw feed and fluids under certain carefully delineated conditions.5 Some of the research underpinning this guidance refers to a lack of hunger and thirst in adults who are approaching death. To assume that babies who are facing death because of congenital abnormalities are similar to adults dying from cancer is a big step. To think that such infants do not feel hunger, or thirst, is a huge supposition.

The General Medical Council (GMC) provides a detailed framework for the provision of food and fluid during “end of life” care.2 The guidance suggests that when death may not be imminent (as in the case described1) that “you must be prepared to provide” clinically assisted nutrition and hydration and you may then have further discussions with the patient’s family to decide whether such treatments will provide overall benefit to the patient. If the decision is that clinically assisted nutrition and hydration will cause unbearable suffering for the patient, the suggestion is that a second opinion and possibly legal advice will be necessary.

Any clinician providing end of life care would do well to reflect on the basic principles underlying palliative care, as enshrined in the WHO definition: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering.”6

Notes

Cite this as: BMJ 2012;345:e8000

Footnotes

  • Competing interests: None declared.

References