. 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).
I think the case of Baby Sherman is particularly challenging for the healthcare professionals involved as they need to not only be advocates for Baby Sherman, but also respectful of the parents’ autonomy. If a staff RN approached me to share his or her comments on the case, I would first respond by letting him or her know that I understand the concern, but that the parents are the primary decision makers for the child. We should trust that the parents are using the best interest standard in making this decision and that they are “sacrific[ing] their personal goals for their child in favor of the child’s needs and interests,” (Butts & Rich, 2016, p. 168).
I think it is important to be mindful of how stressful and agonizing it is for the parents to make a life-or-death decision for their child. I would also note that only a small number of infants with an “Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic outcome,” (“Women’s Health Care Physicians”).
If the staff RN was still concerned about the parents’ decision and did not think that they were acting in the best interest of their child, I would remind him or her that it is also his or her responsibility to advocate for Baby Sherman. I would share with him or her the principles that should be followed to override parental autonomy, including evaluating the “severity of the child’s condition and the direct harm to the child that could result from nontreatment,” (Butts & Rich, 2016, p. 170). I would encourage him or her to consult an interdisciplinary team of healthcare professionals and also to involve an ethics committee if they have not already been consulted. The ethics committee should also consider seeking input from ethicists who practice pediatric care (Butts & Rich, 2016, p. 175)
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