Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 813-822 (doi:10.1542/peds.2009-1299)
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CLINICAL REPORT

Forgoing Medically Provided Nutrition and Hydration in Children

Douglas S. Diekema, MD, MPH, Jeffrey R. Botkin, MD, MPH Committee on Bioethics

There is broad consensus that withholding or withdrawing medical interventions is morally permissible when requested by competent patients or, in the case of patients without decision-making capacity, when the interventions no longer confer a benefit to the patient or when the burdens associated with the interventions outweigh the benefits received. The withdrawal or withholding of measures such as attempted resuscitation, ventilators, and critical care medications is common in the terminal care of adults and children. In the case of adults, a consensus has emerged in law and ethics that the medical administration of fluid and nutrition is not fundamentally different from other medical interventions such as use of ventilators; therefore, it can be forgone or withdrawn when a competent adult or legally authorized surrogate requests withdrawal or when the intervention no longer provides a net benefit to the patient. In pediatrics, forgoing or withdrawing medically administered fluids and nutrition has been more controversial because of the inability of children to make autonomous decisions and the emotional power of feeding as a basic element of the care of children. This statement reviews the medical, ethical, and legal issues relevant to the withholding or withdrawing of medically provided fluids and nutrition in children. The American Academy of Pediatrics concludes that the withdrawal of medically administered fluids and nutrition for pediatric patients is ethically acceptable in limited circumstances. Ethics consultation is strongly recommended when particularly difficult or controversial decisions are being considered.

Key Words: ethics • fluids • nutrition • withholding life-sustaining treatment • children • hydration • end-of-life decision-making

Abbreviations: AAP—American Academy of Pediatrics • CNS—central nervous system • CAPTA—Child Abuse Prevention and Treatment Act


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 AAP NewsHome page
S. Cash
End-of-life care: Report offers guidance on the ethics of withholding fluids, nutrition delivered through medical devices
AAP News, August 1, 2009; 30(8): 1 - 1.
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Does Withdrawal of Nutrition and Hydration Cause Death in Children?
G. Kevin Donovan
Pediatrics Online, 11 Aug 2009 [Full text]