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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
dawngloves, BSN, RN
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