Posted: June 1st, 2018

Withdrawal of nutrition and hydration is a difficult and controversial subject especially when it comes to pediatric patients.

1. I think the staff RN’s comments are beyond inappropriate and actually quite callous. Unless this nurse has gone through a similar situation herself, she has no idea what the parents are going through. I’m sure the decision to withdraw nutrition and hydration from their newborn was far from an easy decision. Baby Sherman was born with an Apgar score of 0 and hypoxic injury to all her organs. This leaves VERY little chance of success. According to the Baby Doe rules, withdrawing treatment is permissible under 3 circumstances.

• i) The infant is chronically and irreversibly comatose;      
• ii) The provision of such treatment would merely      prolong dying, not be effective in ameliorating or correcting all of the      infant’s life-threatening conditions, or otherwise be futile in terms of      the survival of the infant; or 
• iii) The provision of such treatment would be virtually      futile in terms of the survival of the infant and the treatment itself      under such circumstances would be inhumane. 

Under these rules, withdrawing nutrition and hydration is actually the most humane decision. Although Baby Sherman was able to be weaned from the ventilator, she has remained unresponsive. As long as the physicians and nurses are in agreement that treatment would be “virtually futile” and only prolong inevitable death, withdrawing is not the wrong decision. The parents are not being selfish in any way by accepting that. I would remind the staff RN of the Baby Doe rules to show that the parents are not merely being selfish. I would also remind her that as a nurse she needs to remain understanding and empathetic of her patients and their families.

2. Withdrawal of nutrition and hydration is a difficult and controversial subject especially when it comes to pediatric patients. The American Academy of Pediatrics (AAP) “supports allowing the withholding and withdrawing of a medical intervention when the projected burdens of the intervention outweigh the benefits to the child,” (Diekema & Botkin, 2009, p. 813).