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Ethical Issues in Breastfeeding Support

Born in Brooklyn, New York, Dr. Gartner received his undergraduate education at Columbia University and his medical degree from Johns Hopkins University. Returning to New York after internship in Pediatrics at Hopkins, he continued his training in Pediatrics at the Albert Einstein College of Medicine, specializing in neonatology and pediatric liver disease. The great majority of his basic laboratory and clinical research has been in the area of neonatal jaundice, with particular reference to its relationship to breastfeeding. He continued his combined work in bilirubin metabolism and breastfeeding in Chicago and has now published more than 200 papers on this subject and on other aspects of breastfeeding.

Dr. Gartner was Founding Chair of the Executive Committee of the Section on Breastfeeding of the American Academy of Pediatrics from 1998 to 2006. He is also a Past- President of the Academy of Breastfeeding Medicine, of which he is a founder, and a Past-President of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, which he also helped found. He lectures regularly on breastfeeding issues. He is currently Chair of the ABM Ethics Committee.

At the 2011 ILCA Conference in San Diego, CA, Dr. Gartner presented this plenary session titled, “Ethical Issues in Breastfeeding Support.”

Lawrence M. Gartner, M.D., FAAP
Professor Emeritus
Departments of Pediatrics and OB/GYN
The University of Chicago

Ethics is the discipline dealing with what is good and bad or what is right and wrong.  Every health practitioner must adhere to the highest standards of ethical behavior and assure that their practice provides the best possible care for their patients.   As breastfeeding practitioners, we take responsibility for our patients, both the mother and the child, and we must give them every reason to trust our knowledge and our judgment.

To fulfill these ethical standards the practitioner must know the proven scientific facts and accepted practices in the field.  These must always be presented to the patient honestly and completely.  At the same time we must recognize that the mother makes the final decision, based on the information that has been presented to her.  It is never acceptable to use coercion.

Other ethical concerns are to assure confidentiality of all information obtained in the course of caring for the patient. Records must be secure at all times.  Discussion of patients with colleagues or students should be discrete and private, protecting the identity of the patient.  The patient’s privacy must be honored during examinations.  Students may be present at the interview or examination  only with the specific consent of the patient.  One must be aware of cultural differences and  avoid bias in making decisions.  All procedures must be performed only after obtaining fully informed written consent.

Among the most difficult and challenging ethical issues is that of avoiding conflict of interest.   Financial interest in a product that one recommends or provides is a conflict of interest and may result in a recommendation that is not necessarily in the best interest of the patient.  In the practice of breastfeeding an seo consultant, the renting or selling of breastfeeding pumps and supplies is particularly troubling.

In the world of breastfeeding, commercialism or the marketing and sale of products for profit, independent of health care practitioners, has become a major force and often brings a great deal of marketing pressure on breastfeeding mothers and their families.  Most prominent among these are the infant formula companies and their efforts to promote sale of their breastmilk substitutes through practices that are considered unethical or highly questionable.  As practitioners we must make every effort to distance ourselves from their marketing ploys.  Thus, we should not distribute their “educational” materials or hang their posters in our offices.  We also must avoid the subtle temptations of a free lunch or a gift from them as these have been shown to bias our prescribing practices.

We must also have ethical awareness with regard to the hospitals, clinics and other institutions in which we may work or be employed.  These may have conflicts of interest or policies that are not in the best interest of the breastfeeding dyad.  They may provide discharge gift bags possibly because they are being given a grant from the company.  Employees and those who use these facilities can influence the administration to change these unethical practices into ethical ones that improve the environment for breastfeeding.

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