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Learning from Deadly Dutch Mistakes


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The Netherlands has earned a dubious distinction in recent years as one of the suicide capitals of the world.Euthanasia of adults and teenagers has been legal there since 2002 and the Dutch Royal Medical Association recently made international headlines by persuading the Dutch government to establish a committee to regulate infant euthanasia. Not that doctors there needed the government’s blessing to practice their healing arts: By their own accounting, Dutch physicians had already been euthanizing about 15 sick babies each year.Euthanasia advocates hail the Dutch model as progressive and reasonable, offering a humane escape from this fallen world for everyone from terminally ill cancer patients to depressed adolescents and sickly infants. If they want to die (or, in the case of newborns, if their parents wish they had never been born), who has the right to stop them?Read Entire Article From PoliticalMavens.com . . .
Read Wesley’s J. Smith Comments . . .

Colleen Carroll Campbell on Infant Euthanasia on National Review Online

Colleen Carroll Campbell on Infant Euthanasia on National Review Online

March 13, 2006, 8:18 a.m.Chilling ProtocolEnding young life — now, and even here.By Colleen Carroll Campbell
When little Chanou was born in 2000 with a rare and painful illness that leads to abnormal bone development, doctors gave the Dutch infant less than three years to live. As it turns out, she only had seven months.


That’s when her parents and physicians, discouraged by her grim prognosis, joined forces to do something that has become increasingly accepted in the Netherlands: They euthanized her.
“It is in some ways beautiful,” Dutch pediatrician Eduard Verhagen told the London Times, when describing the dying moments of children like Chanou. “But it is also extremely emotional and very difficult.”
Not as difficult as it should be. In the Netherlands, euthanasia of teenagers and adults is legal and baby euthanasia — already practiced among Dutch doctors — will soon be sanctioned by the government. According to the Times, a committee established at the urging of the Dutch Royal Medical Association will begin regulating baby euthanasia in a few weeks. Its standard for deciding who lives and dies will be Verhagen’s own invention, the Groningen Protocol.
The Groningen Protocol is chilling, not only because of its audacity in attempting to judge the worth of human lives but because of its subjectivity in making those judgments. The protocol says that a newborn can be euthanized if his diagnosis and prognosis are “certain,” his suffering is “hopeless and unbearable,” and his quality of life is “very poor,” according to the child’s parents and “at least one independent doctor.”
That standard assumes that physicians are infallible, our current medical knowledge is complete, and human beings are omniscient. How else could one assess with certainty another’s prognosis, experience of suffering, and quality of life? We can know a child suffers; we can know a disease has no known cure. But we cannot pronounce with certainty that another person has no hope or that his suffering has rendered his life worthless. Verhagen himself suggested as much when he told the Times, “No doctor likes to do this. You will always ask yourself, ‘Is there something I have not thought of?’ That is why it needs to be done under a spotlight: you can never, ever be wrong.”
But human beings will be wrong. Discouraged doctors, distraught parents, and distant bureaucrats will make mistakes. And even when their deadly decisions conform perfectly to the protocol, they will commit grave evil by destroying innocent human life in a futile quest to destroy suffering itself.
Americans may be tempted to think that such things could never happen here. But support for infant and child euthanasia has a long history in the United States, stretching from the founding days of the Euthanasia Society of America in 1938 to the recent pronouncements of Peter Singer, a prominent Princeton ethicist who favors a parent’s right to kill disabled newborns.
The threat of euthanasia is already a reality for some American children. Haleigh Poutre, the 12-year-old Massachusetts girl severely beaten by her stepfather last fall, had spent only eight days in the hospital when her state custodians began fighting for the right to remove her ventilator and feeding tube. Doctors had diagnosed her condition as a persistent vegetative state, but Haleigh recovered before they could euthanize her.
Haleigh’s case reminds us that child euthanasia can happen in any nation that has lost respect for the intrinsic value of life and the inviolable dignity of the person. The chilling reality is that although our depraved indifference to the sanctity of human life may not be as advanced as Holland’s, we are moving in that direction.
— Colleen Carroll Campbell, an NRO contributor, is a fellow at the Ethics and Public Policy Center, a former speechwriter to President George W. Bush, and author of The New Faithful: Why Young Adults Are Embracing Christian Orthodoxy.
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NEJM -- The Groningen Protocol -- Euthanasia in Severely Ill Newborns

NEJM -- The Groningen Protocol -- Euthanasia in Severely Ill Newborns

To the Editor: Verhagen and Sauer (March 10 issue)1 emphasize that euthanasia is becoming acceptable medical practice for infants in the Netherlands in whom hopeless and unbearable suffering is present. Doctors are not all-knowing, but pediatric palliative care is a dynamic process that remediates suffering in children through careful assessment and treatment of all symptoms; the quality of life is enhanced, and families are supported.2
Access to pediatric palliation is poor, even in countries with first-class medical systems. A study in the Netherlands3 revealed that the youngest patient receiving palliative care between March 2001 and February 2002 was seven years old. Verhagen and Sauer's conviction that life-ending measures can be acceptable in newborns conflicts with the recommendations Sauer made on behalf of the Confederation of European Specialists in Paediatrics. He and his colleagues invoked the doctrine of double effect and stated that every form of intentional killing should be rejected in pediatrics.4 Perhaps if he and his patients had better access to palliative care, he might return to his ethical stance of 2001.
Dermot M. Murphy, M.B., B.S. Royal Hospital for Sick Children Glasgow G38SJ, United Kingdom dermot.murphy@yorkhill.scot.nhs.uk
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Jon Pritchard, F.R.C.P.(Edin.) Royal Hospital for Sick Children Edinburgh EH91LF, United Kingdom
References

Verhagen E, Sauer PJJ. The Groningen protocol -- euthanasia in severely ill newborns. N Engl J Med 2005;352:959-962. [Full Text]
Thornes R, Elston S, eds. Palliative care for young people, aged 13-24. Bristol, England: Association for Children with Life-Threatening Terminal Conditions & their Families, National Council for Hospice and Specialist Palliative Care Services, Scottish Partnership Agency For Palliative and Cancer Care, September 2001.
Kuin A, Courtens AM, Deliens L, et al. Palliative care consultation in the Netherlands: a nationwide evaluation study. J Pain Symptom Manage 2004;27:53-60. [CrossRef][ISI][Medline]
Sauer PJJ. Ethical dilemmas in neonatology: recommendations of the Ethics Working Group of the CESP (Confederation of European Specialists in Paediatrics). Eur J Pediatr 2001;160:364-368. [CrossRef][ISI][Medline]
To the Editor: Verhagen and Sauer observe that all reported cases of euthanasia in newborns in the Netherlands involved infants with severe forms of spina bifida. Mandatory folic acid fortification of flour would have prevented the development of spina bifida in most of these infants. The failure of the Dutch government and that of many other countries to require folic acid fortification remains a tragic policy error.1 When will European and other governments require this simple, safe, and inexpensive action? Folic acid fortification has been shown in several countries not only to prevent spina bifida, but also virtually to eliminate folate-deficiency anemia and to reduce serum concentrations of homocysteine, with likely reductions in deaths from strokes and heart attacks.2,3,4 I encourage all physicians to advocate forcefully for their governments to require folic acid fortification, using the emergency powers and expedited, short review process provided for in public health regulations. These regulations should be invoked to prevent the severe disease and disability that will continue to occur unnecessarily until mandatory folic acid fortification is implemented.
Godfrey P. Oakley, Jr., M.D. Rollins School of Public Health of Emory University Atlanta, GA 30322 gpoakley@mindspring.com
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Dr. Oakley reports having served as a consultant for Johnson & Johnson and Ortho McNeil.
References

Oakley GP. Delaying folic acid fortification of flour. BMJ 2002;324:1348-1349. [Erratum, BMJ 2002;325:259.] [Full Text]
Mersereau P, Kilker K, Carter H, et al. Spina bifida and anencephaly before and after folic acid mandate -- United States, 1995-1996 and 1999-2000. JAMA 2004;292:325-326. [Full Text]
American Heart Association. Folic acid fortification may have lowered stroke deaths. 2004. (Accessed May 12, 2005, at http://www.americanheart.org/presenter.jhtml?identifier=3019554.)
Casas JP, Bautista LE, Smeeth L, Sharma P, Hingorani AD. Homocysteine and stroke: evidence on a causal link from mendelian randomisation. Lancet 2005;365:224-232. [CrossRef][ISI][Medline]
To the Editor: When my cousin Jay was born, the doctors said, in so many words, that his diagnosis and prognosis were certain: severe spina bifida, a very poor quality of life, and no hope of improvement.1 Jay did suffer. He suffered 26 surgeries and all of the indignities that follow from paralysis, incontinence, and bodily disfigurement. Moreover, like the rest of us, Jay never became fully self-sufficient.
Yet Jay bore his suffering with irrepressible hope and good humor that inspired and encouraged innumerable people who had the privilege of knowing him. When he died three days before his 14th birthday, 2000 people attended the funeral to celebrate Jay's uncommonly rich life. A passerby commented, "Someone important must have died."
With different parents, Jay could have qualified for the Groningen protocol. Doctors might have "performed a deliberate life-ending procedure"1 in Jay after making claims no mortal can sustain2 — that his prognosis was "certain," and his suffering was "hopeless and unbearable."1 Those of us who knew Jay are glad there was no such opportunity.
Farr A. Curlin, M.D. University of Chicago Chicago, IL 60637
References

Verhagen E, Sauer PJJ. The Groningen protocol -- euthanasia in severely ill newborns. N Engl J Med 2005;352:959-962. [Full Text]
Koogler TK, Wilfond BS, Ross LF. Lethal language, lethal decisions. Hastings Cent Rep 2003;33:37-41.
Drs. Verhagen and Sauer reply: We agree with Oakley that folic acid fortification is important. However, it cannot prevent all abnormalities in newborns that cause unbearable suffering.
We cannot comment on Jay's case, described by Curlin, because we did not know him. He suffered, but according to Curlin, the suffering was acceptable. As we noted in our Perspective article, the role of the parents is paramount. Clearly, these parents were supportive, but the question is whether, without these parents, would the suffering have been bearable?
Murphy and Pritchard raise the issue that pediatric palliative care is not always accessible or adequate. They suggest that improvement in palliative care services could lead to a situation in which euthanasia in sick newborns would no longer be practiced. We agree that patients will certainly profit from improved access to palliative care. At the same time, we are convinced that euthanasia in patients with a hopeless prognosis and severe and sustained suffering, waiting for the "ideal" standard of care, can be acceptable. The Groningen protocol was designed to motivate physicians to adhere to the highest standards of decision making and to reduce hidden euthanasia by facilitating reporting. The protocol requires that all possible palliative measures be exhausted before euthanasia is performed. This requirement might do more in mobilizing the availability of palliative care services than the current situation of unreported practice.
The recommendations that Murphy and Pritchard refer to are a consensus statement of pediatricians in Europe.1 Sauer's personal view is that active life-ending procedures can be acceptable.
Eduard Verhagen, M.D., J.D. Pieter J.J. Sauer, M.D., Ph.D. University Medical Center Groningen 9700 RB Groningen, the Netherlands
References

Sauer PJ. Ethical dilemmas in neonatology: recommendations of the Ethics Working Group of the CESP (Confederation of European Specialists in Paediatrics). Eur J Pediatr 2001;160:364-368. [CrossRef][ISI][Medline]