To consent, or not to consent, that is the question: Ethical issues of informed consent for the use of donor human milk in the nicu setting

Kelly McGlothen-Bell, Lisa Cleveland, Britt Frisk Pados, Leslie A. Parker

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Evidence supports the superiority of mother's own milk (MOM) in reducing the comorbidities common to prematurity and very low birth weight. In situations where an insufficient amount of MOM is available or maternal contraindications prevent its use, pasteurized donor human milk (DHM) is a viable substitution. When DHM is deemed best, a common practice in many neonatal intensive care units (NICUs) is for parents to provide their consent. However, no universal mandate for informed consent exists. Often, healthcare providers present and obtain the consent for DHM use prior to delivery or shortly after birth and this consent may be "bundled" along with other standardized NICU treatment consents. This approach is likely less than ideal since it provides insufficient time for decision making and often precedes the mother's ability to initiate the expression of her own milk. Purpose: To review the history of DHM use and the ethics surrounding the consenting process including the ethical principles involved in infant feeding decision making. We argue for the standardization and consistent use of informed consent for DHM in the NICU and offer clinical practice implications. Findings/Results/Implications for Practice and Research: Providers face several challenges in the consenting process for the use of DHM in the NICU setting. These include limited time to support parents and educate them appropriately during the decision-making process. Standardized and consistent use of informed consent is essential to address the ethical concerns surrounding the use of DHM in the NICU setting.

Original languageEnglish (US)
Pages (from-to)371-375
Number of pages5
JournalAdvances in Neonatal Care
Volume19
Issue number5
DOIs
StatePublished - Oct 1 2019

Keywords

  • donor human milk
  • ethics
  • human milk
  • informed consent
  • neonatal intensive care unit
  • parental autonomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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