It is ethical to withhold and withdraw artificial
nutrition and hydration (ANH) from children, says the Canadian Paediatric
Society. In a
bioethics position statement, it argues that medically assisted food and
water are medical treatment, not an essential part of humane care.
The CPS makes clear that any decision
should be based solely on the benefit to the child, while considering the
child’s overall plan of care.
“Food and drink evoke deep emotional and
psychological responses, and are associated with nurturing,” said Dr. Tsai.
“But artificial nutrition and hydration is not about providing food and fluids
through normal means of eating and drinking. It should be viewed the same as
any other medical intervention, such as ventilatory support.”
“The discussion on whether to withhold or
withdraw artificial nutrition and hydration is happening more and more,” said
Dr. Ellen Tsai, chair of the CPS Bioethics Committee. “It’s a difficult topic,
one where physicians are being asked questions by both parents and their health
care colleagues. They need guidance to navigate the complexity of the issue.
Saying we don’t withhold or withdraw ANH isn’t a sufficient response anymore.”
The Canadian guidance is based on a 2009
report from the American Academy of Pediatrics recently published a
comprehensive clinical report, “Forgoing medically provided nutrition and
hydration in children” which states that in some circumstance ANH may be
The CPS clearly expects resistance to the
new guidelines. Its advice says that “some members of any health care team may
harbour personal or professional objections” and that they may have to recuse
themselves from a child’s treatment. ~ McGill University
Health Centre, Apr 1