# Should Clinically Assisted Hydration and Nutrition Ever Be Withdrawn for a Neonate with a Chronic Non-Progressive Neurological Condition? A Case Study

## TL;DR

This case study explores the ethical dilemma of withdrawing nutrition and hydration from a neonate with uncertain neurological outcomes and poor quality of life.

## Contribution

The paper provides a nuanced ethical analysis of feeding withdrawal in neonates with non-progressive neurological conditions.

## Key findings

- Enteral feeding in neonates with severe neurological impairment should be considered a medical intervention requiring careful ethical evaluation.
- Stakeholder perspectives, including parents and healthcare teams, are critical in assessing the benefits and burdens of feeding withdrawal.
- Uncertainty in developmental outcomes complicates decisions about allowing natural death in neonates.

## Abstract

Background: For infants, withholding or withdrawal of feeding is ethically permissible when the child is imminently dying or chronically and irreversibly comatose. It can also be appropriate in cases of medical futility with a low chance of survival. However, there is much contention in situations where the medical prognosis is uncertain. Case presentation: Annie is a 6-week-old neonate with antenatally acquired cystic encephalomalacia, a chronic non-progressive neurological condition. Her future neurological outcome is uncertain. She is putting on weight in the NICU with stable cardiorespiratory status on room air and tolerates full nasogastric tube feeding but requires frequent oropharyngeal suctioning. Her parents ask to stop tube feeding and allow Annie to die. They deem she has a poor quality of life and is experiencing tremendous suffering. Discussion: Parents’ perceptions of “best interest” and “physical suffering” are explored, alongside those of the healthcare team. Concomitant issues like feeding withdrawal and moral distress are examined in context—that of a newborn where developmental outcomes and disease trajectory are unclear. Conceptual frameworks, empirical evidence and consensus-based ethics guidelines informed a rich and multi-dimensional exposition of a difficult and value-laden decision. Conclusions: While instinctively legitimate, enteral feeding in an infant, in this case with severe neurological impairment, is ultimately still a medical intervention. In contrast to prevailing conventions within adult medicine, the careful and nuanced consideration of benefits and burdens from different stakeholders’ perspectives is critical before any deliberate withdrawal to allow natural death.