CPS: Withholding or withdrawing artificial nutrition and hydration is legally, ethically acceptable

The Canadian Paediatric Society wants to help health care providers faced with difficult end-of-life decisions, with a new paper on withholding or withdrawing artificial nutrition and hydration (ANH). The CPS says that withholding or withdrawing ANH is both legally and ethically acceptable as part of a palliative care plan.

"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, and author of the new CPS practice point published today in Paediatrics & Child Health. "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."

ANH refers to nutrition or hydration that is delivered by artificial means, such as via a feeding tube or intravenously. Legal and ethics experts say there is no difference between withholding or withdrawing ANH versus other therapies that sustain or prolong life. 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 CPS hopes to stimulate discussion on the issue with health care professionals and provide the impetus for more hospitals across the country to develop their own policies.