Withdrawal of artificial nutrition and hydration in the Neonatal Intensive Care Unit: parental perspectives

Abstract

Within the spectrum of palliative care in neonates, WANH can be a tenable, justifiable and humane practice in the NICU.

End-of-life care in Toronto neonatal intensive care units: challenges for physician trainees: Table 1

“…In Toronto NICUs, the experience of the practice of withdrawal of artificial nutrition and hydration has been studied and parental perspectives on the process have been described 20. Although some trainees in the present study may hold personal or professional reservations, withholding or withdrawing artificial nutrition and hydration is legally and ethically permissible in well-defined circumstances, when the perceived benefits of artificial nutrition and hydration are outweighed by significant burdens, such as when it will only prolong survival without supporting quality of life, or when it is initiated as a bridge to improvement but the expectation cannot be fulfilled 21 22.…”

Infants’ Best Interests in End-of-life Care for Newborns

“…Clinical experience indicates that the duration of the dying process may be several hours and sometimes as long as several days; however, literature on the subject is very scarce. [12][13][14] There is also not sufficient knowledge about possible suffering as a consequence of withdrawing nutrition and hydration. Because it cannot be excluded, physicians need to discuss comfort care, including sedation, with parents.…”

Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions

“…In fact, studies have shown that parents do not wish to be given false hope when they are seeking information about their child [42]. They have also repeatedly indicated that they do not want to be stripped of all hope but, at the same time, do not welcome healthcare professionals providing false hope [32,34,37,46,53,54].…”

“…Parents often recognise and accept the uncertainties and unpredictability of their child's condition, which impacts on the potential outcomes and options for their child, and they appreciate it when healthcare professionals admit to the unpredictability involved [1,30,46,53,54]. In fact, studies have shown that parents do not wish to be given false hope when they are seeking information about their child [42].…”