Baby O and the Withdrawal of Life-Sustaining Medical Treatment in the Devastated Neonate: A Review of Clinical, Ethical, and Legal Issues

2016 ◽  
Vol 34 (10) ◽  
pp. 925-930 ◽  
Author(s):  
Joseph Sacco ◽  
Rebecca Virata
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Research ◽  
Medical Treatment ◽  
Clinical Guidelines ◽  
Legal Issues ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Ethical And Legal Issues

The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care.

scholarly journals “You Can't be any Poorer than Dead”: Difficulties in Recognizing Artificial Nutrition and Hydration as Medical Treatments

1994 ◽  
Vol 61 (2) ◽  
pp. 77-87
Author(s):  
Stephen J. Heaney
Keyword(s):  
Medical Treatment ◽  
Natural Law ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Medical Treatments ◽  
Great Caution ◽  
Do No Harm ◽  
Commission Report ◽  
Life Sustaining Treatment ◽  
Nutrition And Hydration

The President's Commission Report Deciding to Forego Life-Sustaining Treatment comes down squarely in favor of two propositions: 1) artificial provision of nutrition and hydration are medical treatments, and 2) as such, these medical treatments may be foregone by certain categories of patients or their proxies. This latter conclusion is based on roughly consequentialist grounds; the former is more assumed than argued There is a school of thought opposed to both of these conclusions. After first demonstrating that nourishment is not medicine, a non-consequentialist or natural law argument is employed to show that nourishment may not be foregone insofar as it violates the principle, “First, do no harm.” I was once a member of this school, and this paper was to argue its position. In the end, however, this paper adopts the position that artificial provision of nourishment and hydration can be medical treatments, and as such may be foregone by certain categories of patients, without violating a natural law understanding of “First, do no harm “Still, exposing my retained sympathies for my former position, the paper attempts to argue for a very careful standard for non-treatment. As a result, the argument of the paper takes four steps. First, I present the argument that artificial provision of nutrition is never medical treatment, giving as much strength to that argument as possible. Second, I show how the focus of that argument leads it astray, and that artificial provision of nourishment is medical treatment. Third, I try to show by what standard patients (or proxies) can legitimately forego this medical treatment Fourth, I point out where my former position has valid criticisms of certain arguments used by those who hold that such treatment may be withdrawn, and urge great caution in deciding to forego treatment.

Oncology and Palliative Care Nurses’ Knowledge and Attitudes Toward Artificial Nutrition and Hydration for Patients at End of Life in Italy

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Beatrice Albanesi ◽  
Michela Piredda ◽  
Anna Marchetti ◽  
Chiara Mastroianni ◽  
Caterina Magnani ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Knowledge And Attitudes ◽  
Nutrition And Hydration ◽  
Nurses Knowledge

Artificial nutrition and hydration for children and young people towards end of life: consensus guidelines across four specialist paediatric palliative care centres

2019 ◽  
pp. bmjspcare-2019-001909 ◽  
Author(s):  
Anna-Karenia Anderson ◽  
Kimberley Burke ◽  
Lizzie Bendle ◽  
Michelle Koh ◽  
Renee McCulloch ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Clinical Decision Making ◽  
Artificial Nutrition ◽  
Consensus Guidelines ◽  
Artificial Nutrition And Hydration ◽  
Paediatric Palliative Care ◽  
Nutrition And Hydration

There is a paucity of evidence on the role, use, benefit and challenges of artificial nutrition and hydration (ANH) in children at end of life. Parents express the difficulty they face with making the decision to withdraw ANH. Decision-making on the role of ANH in an individual child requires careful multidisciplinary team deliberation and clear goals of care with children and families. Four paediatric palliative care specialist centres reviewed the current literature and developed consensus guidelines on ANH at end of life. These guidelines seek to provide a practical approach to clinical decision-making on the role of ANH in a child or young person entering the end-of-life phase.

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