Re: How it feels to withdraw feeding from newborn babies
Neonatal Palliative care – a reflection on current GMC guidance
I read with interest the recent BMJ article entitled: ‘How it feels to withdraw feeding from a newborn baby.’ Although I appreciate that this is an interesting and poignant reflection, I do not believe that the piece represents current practice in the UK, or aligns the case to current UK guidance1,2,3.
The article references the American4 and Canadian5 guidance on the subject, which indeed suggests that it may be ethically appropriate to withdraw feed and fluids under certain carefully delineated conditions. It is interesting to note that the research underpinning this guidance mostly relates to adults, and refers to a lack of hunger and thirst in those who are approaching death. It would be extremely difficult to assume that babies who are facing death because of congenital abnormalities are similar to cachectic adults dying from cancer. It is a huge supposition to think that such infants do not feel hunger, or thirst.
The General Medical Council (GMC)1 provides a detailed framework for the provision of food and fluid during ‘end of life’ care. The guidance specifically acknowledges concerns that a patient who is not able to talk about how they feel may yet be experiencing distressing symptoms and may be suffering. The guidance suggests that where death may not be imminent (as in this described case) ‘you must be prepared to provide these treatments’ (clinically assisted nutrition/hydration) and that 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 definition6 ‘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…’
Dr L de Rooy
St George’s Hospital NHS Trust
1. Treatment and care towards the end of life: good practice in decision making. General Medical council, May 2010. Available at http://www.gmc-uk.org/guidance/ethical_guidance.asp
2. Association for Children’s Palliative Care. (ACT) A neonatal Pathway for Babies with Palliative Care Needs. Katrina McNamara-Goodger. November 2009
3. British Association of Perinatal Medicine: Palliative Care (supportive and end of life care). A Framework for Clinical practice in Perinatal Medicine, August 2010, at: http://www.bapm.org/media/documents/P%20alliative%20Care%20Report%20fina...
4. Diekema DS, Botkin JR. Committee on Bioethics. Clinical report- foregoing medically provided nutrition and hydration in children. Pediatrics 2009;124:813-22.
5. Tsai E. Withholding and withdrawing artificial nutrition and hydration. Paediatrc Child Health 2011;16:241-2.
6. World Health Organisation. http://www.who.int/cancer/palliative/definition
Competing interests: No competing interests