April
09
 

Food and water are medical treatments, say Canadian ethicists

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 morally optional.

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



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