Euthanasia battle's new focus: Infants

[dawngloves, BSN, RN]

http://www.philly.com/mld/philly/classifieds/real_estate/10325794.htm

Euthanasia battle's new focus: Infants

The Dutch were the first to legalize adult cases. But newborns? A hospital stunned critics.

By Toby Sterling

Associated Press

AMSTERDAM - A hospital in the Netherlands, the first nation to legalize euthanasia, recently proposed guidelines for so-called mercy killings of terminally ill newborns and then made a startling revelation: It already had begun carrying out such procedures, which include administering a lethal dose of sedatives.

The announcement by the Groningen Academic Hospital came amid a growing discussion in the Netherlands on whether to legalize euthanasia for people incapable of deciding for themselves whether they want to end their lives - a prospect viewed with horror by euthanasia opponents and as a natural evolution by advocates.

In August, the Dutch doctors' association KNMG urged the Health Ministry to create an independent board to review euthanasia cases for terminally ill people "with no free will" - including children, the severely mentally retarded, and people left in irreversible coma after an accident.

The Health Ministry is preparing its response, a spokesman said.

Three years ago, the Dutch parliament made it legal for doctors to inject a sedative and a lethal dose of muscle relaxant at the request of adult patients suffering great pain with no hope of relief.

The Groningen Protocol, as the hospital's guidelines have come to be known, would create a legal framework for permitting doctors to actively end the lives of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when a child's medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it is best.

Examples include extremely premature births, in which children suffer brain damage from bleeding and convulsions, and diseases that would allow a child to survive only on life support for the rest of his or her life, such as severe cases of spina bifida and epidermolysis bullosa, a rare blistering illness.

The hospital revealed it had carried out four such deaths in 2003, and reported all cases to government prosecutors. There have been no legal proceedings against the hospital or the doctors.

Roman Catholic organizations and the Vatican have reacted with outrage to the announcement, and U.S. euthanasia opponents say the proposal shows the Dutch have lost their moral compass.

"The slippery slope in the Netherlands has descended already into a vertical cliff," Wesley J. Smith, a prominent California-based critic, said in an e-mail to the Associated Press.

Child euthanasia remains illegal everywhere. Experts say doctors outside the Netherlands do not report cases for fear of prosecution.

"As things are, people are doing this secretly, and that's wrong," said Eduard Verhagen, the head of Groningen's children's clinic. "In the Netherlands we want to expose everything, to let everything be subjected to vetting."

According to the Justice Ministry, four cases of child euthanasia were reported to prosecutors in 2003. Two were reported in 2002, seven in 2001, and five in 2000. All the cases in 2003 were reported by Groningen, but some of the cases in other years involved other hospitals.

Groningen estimated the protocol would be applicable in 10 cases per year in the Netherlands, a country of 16 million people.

Since the introduction of the Dutch law, Belgium also has legalized adult euthanasia. In France, legislation to allow doctor-assisted suicide is under debate. In the United States, Oregon is alone in allowing physician-assisted suicide, but this is under constant legal challenge.

However, experts acknowledge that doctors euthanize routinely in the United States and elsewhere, but say the practice is hidden.

"Measures that might marginally extend a child's life by minutes or hours or days or weeks are stopped. This happens routinely, namely, every day," said Lance Stell, professor of medical ethics at Davidson College in Davidson, N.C., and staff ethicist at Carolinas Medical Center in Charlotte. "Everybody knows that it happens, but there's a lot of hypocrisy. Instead, people talk about things they're not going to do."

Euthanasia in the U.S.

Euthanasia, the deliberate killing of a human being for medical reasons, is illegal in the United States for children and adults.

While doctors used to debate whether newborns experienced pain, experts now conclude that they do and say that it should be treated thoroughly.

No hard and fast rules exist on when to stop providing care for extremely premature or critically ill newborns in the United States. Doctors must evaluate a newborn's expected quality of life from the child's perspective and predict future developments. The question is handled by doctors consulting with parents. U.S. hospitals tend to undertake more heroic measures than in Europe, in part because of the wide availability of technology and doctors.

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SOURCES: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families, Institute of Medicine, 2003. Treatment Decisions for Seriously Ill Newborns, American Medical Association

[Stitchie]

I think this article is both horrifying and strangely merciful to those who cannot survive with any hope of quality of life.

The trouble is that slippery slope concept -- where do you end up drawing the line, really? Severe spina bifida OK, what about severe CP? What about children born with Down's syndrome? What about micropremies with those grade 4 ventricular bleeds who will only survive on a vent and then not for very long?

Too many questions! Too many grey areas! I think this is a very tough ethical subject and I agree that doctors probably do allow patients to expire or even help them along and nobody talks about it. There are so many diseases out there that are truly horrible -- ALS and Huntington's being among the most cruel for adults. How do you decide who lives and who doesn't?

Ethically this is too much for me to handle. I don't think doctors should be put in this position under any circumstances -- it's too much power, and if a mistake occurs, the consequences are horrific. We've all been able to question orders.

What's next? "Administer lethal dose of K+, stat"?

[fergus51]

Am I the only person who has never seen a doc help a patient die? Everytime I read these stories they say that docs routinely kill people and no one talks about it. My experience has been that docs will be insanely agressive at treating hopeless cases, and it's generally very difficult to get them to discuss the reality of the situation with parents to even get them to make a kid a DNR.

btw, there are two other posts about this in current events and the breakroom I think.

[robsta]

Am I the only person who has never seen a doc help a patient die? Everytime I read these stories they say that docs routinely kill people and no one talks about it. My experience has been that docs will be insanely agressive at treating hopeless cases, and it's generally very difficult to get them to discuss the reality of the situation with parents to even get them to make a kid a DNR.

btw, there are two other posts about this in current events and the breakroom I think.

No, you're not the only one who's witnessed a doc euthanise a patient - either with or without their consent. The article below claims that 45% of neo-natologists surveyed in a Dutch study admitted to having killed infants under their care.

Now They Want to Euthanize Children

In the Netherlands, 31 percent of pediatricians have killed infants. A fifth of these killings were done without the "consent" of parents. Going Dutch has never been so horrible.

by Wesley J. Smith

09/13/2004 12:00:00 AM

For anyone paying attention to the continuing collapse of medical ethics in the Netherlands, this isn't at all shocking. Dutch doctors have been surreptitiously engaging in eugenic euthanasia of disabled babies for years, although it technically is illegal, since infants can't consent to be killed. Indeed, a disturbing 1997 study published in the British medical journal, the Lancet, revealed how deeply pediatric euthanasia has already metastasized into Dutch neo natal medical practice: According to the report, doctors were killing approximately 8 percent of all infants who died each year in the Netherlands. That amounts to approximately 80-90 per year. Of these, one-third would have lived more than a month. At least 10-15 of these killings involved infants who did not require life-sustaining treatment to stay alive. The study found that a shocking 45 percent of neo-natologists and 31 percent of pediatricians who responded to questionnaires had killed infants.

It took the Dutch almost 30 years for their medical practices to fall to the point that Dutch doctors are able to engage in the kind of euthanasia activities that got some German doctors hanged after Nuremberg. For those who object to this assertion by claiming that German doctors killed disabled babies during World War II without consent of parents, so too do many Dutch doctors: Approximately 21 percent of the infant euthanasia deaths occurred without request or consent of parents. Moreover, since when did parents attain the moral right to have their children killed?

***

robsta

:)

[fergus51]

No Robsta, I said I have NEVER seen a doc euthanize. That's why I'm asking. I always see these stats that say docs are killing people all the time, but in my experience it's the exact opposite. Docs I know are always wanting to treat even when things are hopeless because they can't seem to accept defeat.

How about any other NICU nurses out there? Anyone seen all this rampant euthanasia before?

[robsta]

No Robsta, I said I have NEVER seen a doc euthanize. That's why I'm asking. I always see these stats that say docs are killing people all the time, but in my experience it's the exact opposite. Docs I know are always wanting to treat even when things are hopeless because they can't seem to accept defeat.

How about any other NICU nurses out there? Anyone seen all this rampant euthanasia before?

Oops! My apologies. Très :imbar However, my post still stands - drs. in the Netherlands are killing patients - the elderly, teenagers, children, infants... and now newborns.

robtsa

:)

[Spidey's mom, ADN, BSN, RN]

I think there is a big difference in withdrawing life support and actively killing someone.

Yes, I've seen patients with cancer allowed to die. I've been involved in Hospice cases where patients are given pain relief and don't buy the idea that the morphine is what kills people. In fact there are many studies that state the opposite. Giving people pain relief should not be stopped due to fear of pushing them over the edge.

But what is happening in the Netherlands is very scary.

steph

[TiffyRN, BSN, PhD]

I've seen plenty of "withdrawal" of support in our unit for grade 4 bleeds or bad NEC when the infant is deemed too small (

[Katmae RN]

The docs order the prn meds for comfort..it's the nurse who decides when and how often to give them in what i have experienced. We are with the patient 24/7..and witness all that they go thru in a hopeless, terminal condition. Last night a 98 yr old lady we have been caring for has become emaciated,lifeless as a ragdoll, except when she is disturbed to change her, or turn her. Lost 30 pounds in last month and refuses all food and drink. All her adl's are done by nursing staff. Finally last night the doc ordered Ativan for her prn. She gets very sob and anxious when we touch her. She has periods of 1 minute apnea and you really have to look closely to see if she is still with us. It has been suggested we get an order for morphine if she is still anxious after ativan. Depending on the nurse..isn't it possible that she could be helped along with the end of her life. It's the nurse's interpretation of what should be given, and why at that point. Difficult dilemma, watching someone die by the "inch" for days and yet not want to be the one who gave her the final dose. Those of us who have cared for her for years, don't want her suffering to go on.We all know it's time and that she has decided to end her life by not eatting or drinking. I dunno..just venting. Hope she is at peace soon.

[Katmae RN]

Wow did i put that post in the wrong place or what..I just read neonatal nurses. I'm babbling about a 98 yr old woman jeez. But euthanasia does cross all age groups..and it is us nurses at the bedside with them.

[KRVRN, BSN, RN]

I've always been a little surprised that in light of the euthanasia debate, you never really hear much about our practice of withdrawing nutrition and fluid. No, it's not actively injecting something that kills the pt, but I imagine some euthanasia opponents could see it as morally wrong since a neonate relies on others to take care of it... like it's not just a matter of not forcing fluids onto a dying pt that doesn't want them.

I would imagine euthanasia opponents would see withdrawing fluid and nutrition on a pt that's not actively dying and doesn't have less than X amount of time to live as wrong. Extubating a baby that can't breath effectively on it's own is different than withdrawing feedings on a baby with no quality of life.

[KarafromPhilly]

"Examples include extremely premature births, in which children suffer brain damage from bleeding and convulsions, and diseases that would allow a child to survive only on life support for the rest of his or her life, such as severe cases of spina bifida and epidermolysis bullosa, a rare blistering illness."

I don't have any children, and maybe there's something wrong with me, but I don't see any reason to keep a child alive to suffer. Is it me?