November 30, 2022

Groningen protocol” for euthanasing infants published in NEJM

Dr Eduard Verhagen (New York Times) The Dutch doctors at the centre of an international controversy about euthanasing infants with extremely poor quality of life have used the New England Journal of Medicine to publicise their ticklist for determining when doctors can legitimately kill children with their parents’ consent.

Dr Eduard Verhagen and his colleague Peter Sauer, of Groningen University Medical Center, say that 22 cases of infant euthanasia have been reported to district attorneys’ offices in the Netherlands over the past seven years, all of which involved severe cases of spinal bifida. Although these were clearly illegal, none of the doctors were prosecuted. The authors freely admit that they have killed four children in accordance with their protocols. Dutch authorities have not acted in these cases either.

The requirements proposed by Verhagen and Sauer are simple: hopeless and unbearable suffering, a certain diagnosis and prognosis, confirmation by another doctor, the informed consent of the parents, and accepted medical practice. The age of the children is not mentioned. Presumably, then, it would apply for children from birth to 12, as 12-year-olds already have a right to euthanasia under Dutch law. The authors contend that the 22 reported cases are just the tip of a euthanasia iceberg and that if infant euthanasia were legalised, it would be possible to prevent “uncontrolled and unjustified euthanasia”.

Verhagen and Sauer were warmly supported by Professor Peter Singer in a Los Angeles Times opinion piece. The Dutch doctors divided handicapped children into three groups: infants who have no chance of survival; infants who can survive only in intensive care; and infants who can survive without intensive care, but will have an extremely poor quality of life. Professor Singer says that if it is ethical to withdraw life support from children in the second group, it must be ethical to withdraw life from children in the third. In any case, he advises, don’t sweat the small stuff. Americans ought to worry that their infant mortality rate is 30% higher than the Netherlands rather than working themselves into a lather over the deaths of 22 “tragically afflicted infants”.

Agreeing with Singer was the editor of the American Journal of Bioethics, Glenn McGee, who says that “these babies are not being killed; they are being appropriately cared for”. However, a leading US paediatrician, Dr Ian R. Holzman, of Mount Sinai Hospital in New York, told ABC News that “when I was younger I believed I had a prognosticope’ that could tell who do OK and who wouldn’t. I am much less sure now since I have seen infants with conditions thought to be dismal who have survived and gone on to have lives much better than predicted.”