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Date: | Wed, 1 Nov 2006 12:35:50 EST |
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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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