The New England Journal of Medicine has published several letters from doctors indignant with a justification of infant euthanasia recently published by two Dutch colleagues. A public health expert from Emory University in Atlanta commented that all reported cases of euthanasia involved infants with severe spinal bifida. But this is a consequence, he claims, of the failure of the Dutch government to require folic acid fortification. If the government had the will to enforce this, it could prevent unnecessary severe disease and disability.

Two Scottish doctors pointed out that “access to paediatric palliation care is poor, even in countries with first-class medical systems”. A third doctor spoke of a cousin with severe spinal bifida who died at 14 after an “uncommonly rich life”. It is impossible to give a “certain” prognosis that a child’s suffering will be “hopeless and unbearable”, he contended.

The authors of the original article, Drs Eduard Verhagen and Pieter Sauer, responded that euthanasia is still appropriate for children who do not have supportive parents or when adequate palliative care is not available.