I have just finished contributing as an expert witness in a law suit that  
involved discharging a non-feeding breastfed infant from the hospital and the  
resulting unfortunate outcome. One of the first set of documents I was asked to 
 produce was the (old) LC standards of practice and the LC scope of  
practice. This was scrutinized by the attorney for failure of the LC to perform  what 
was called for in these documents, part of which related to the LC's  failure 
to recommend to the physician that the baby not be discharged. Our duty  and 
obligation is to the patient (mother and baby), called  fidelity, not to who 
employs us or who we work with. Otherwise a conflict  of interest is created 
between the interests of the patient and the competing  interests. These new 
standards have bypassed the ethical underpinnings of our  profession: beneficence 
and veracity (the moral obligation to provide complete  and accurate 
information) and non-maleficence (the obligation to avoid physical  or mental harm to 
the patient). Non-maleficence also includes the obligation of  not imposing the 
RISKS for harm, which these new Standards if Practice clearly  do. This 
ethical dilemma places us in a moral and legal bind right now. It  matters greatly 
what those standards say and muzzling the LC with restrictive  language 
cripples our ability to discharge our obligation to the mothers and  babies 
entrusted to our care. It puts us in legal jeopardy as it pits one set of  documents 
against the other (IBLCE standards vs ILCA standards). The lawyers in  the 
above case would have had a field day with this.
 
How unfortunate that this situation has arisen from within the lactation  
community especially in light of two new articles that validate the importance  
of the IBCLC - the one that Liz just mentioned and the new article in the  
current Journal of Human Lactation by the president of ILCA:
 
Mannel R, Mannel RS. Staffing for hospital lactation programs:  
recommendations from a tertiary care teaching hospital. J Jum Lact 2006;  22:409-417
 
Let's hope for swift action on this and not a 2 year study of minutia. 
 
Marsha Walker, RN, IBCLC
Weston, MA
 
 

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