LLLI Center for Breastfeeding Information

Journal Abstract and Review of the Month for May 2006

"The Ethics of Donor Human Milk Banking"

Authors: Lois D.W. Arnold

Breastfeeding Medicine 2006 April; 1(1):3-13.

Abstract:

It has always been recognized that sometimes human milk must come from a source other than an infant's birth mother. At one time, the services of a wet nurse were procured. People hiring a wet nurse would look for certain qualities in her that would establish whether the wet nurse could provide breastmilk of adequate quantity and quality so as to ensure the survival of the infant, and they would set up rules to protect that milk supply from any potentially harmful behavior on the nurse's part. As times have changed, the role of the wet nurse has been supplanted by the donor human milk bank (DHMB). Information about the efficacy of breastmilk for the infant has increased and so has the demand for human donor milk. This increased demand has given natural rise to questions about how breastmilk can be ethically acquired, handled, stored, and dispensed so as to protect the milk supply from bringing harm to the recipient.

There are two models available for creating DHMB ethical guidelines. The medical model focuses primarily on issues such as autonomy (the right of patients to decide on their own course of treatment); veracity (the need for honesty on the part of all parties involved); nonmaleficence (doing no further harm); beneficence (actively causing good); confidentiality (the right of the patient to privacy regarding his or her condition and treatment); role fidelity (each person having a part to play and functioning only within that role); and justice (primarily as it affects who receives what services and how that is decided). Stresses to some of these guidelines appear in DHMB as it is currently in force, specifically in the use of volunteers to provide the milk (and whose behavior cannot be controlled, only encouraged) and in the office setting (which raises issues of confidentiality with regard to HIPAA regulations). This model is very intimate and personal, concerned mostly with the patient and the health care provider rather than with society at large.

The second model comes from the public health sector and addresses some very different issues. This model is concerned more with the wider society and whether it is wise or fair to ask the community to support a particular venture. It speaks from a framework of considering that what is best for individual must also benefit the society as a whole. The public health model asks whether a particular program is good for the public; whether it can be fairly implemented among the citizens; what the potential benefits and burdens to the community are and whether the former outweighs the latter; and even the simple question of whether the program works. Blood banking in the United States falls into this public health category and offers a beginning point for looking at how milk bank guidelines should be structured.

Each model has components to offer; however, neither model perfectly fits the needs of the human milk banking community.

This paper is categorized by the following keywords:

Milk banks
Ethics
Legal/legislative concerns

The full text of this article is available (for free) at:
http://www.liebertonline.com/doi/pdf/10.1089/bfm.2006.1.3

Note: This abstract features an article in the premier issue of the journal Breastfeeding Medicine, from the Academy of Breastfeeding Medicine.
www.bfmed.org

Additional information on donor human milk banking can be found on the LLLI website at:

http://www.lalecheleague.org/ba/Feb02.html
http://www.lalecheleague.org/Release/milksharing.html
http://www.lalecheleague.org/llleaderweb/LV/LVAprMay00p19.html
http://www.lalecheleague.org/llleaderweb/LV/LVAprMay00p22.html
http://www.lalecheleague.org/llleaderweb/LV/LVJulAug95p53.html
http://www.lalecheleague.org/NB/NBmilkdonation.html

The Human Milk Banking Association of North American maintains a list of milk banks in North America and can be found on the Internet at
http://www.hmbana.org/