“It's time to be honest. All over the world doctors end lives discreetly, out of compassion.” With these words Eduard Verhagen, clinical director of paediatrics at University Medical Centre Groningen, in the Netherlands, gained international notoriety.

He has sparked a professional debate over whether, in exceptional cases, it is humane to kill extremely sick newborn babies if medical treatment cannot alleviate their suffering. His study of Dutch practice, published this week in the New England Journal of Medicine and previously in the Dutch Journal of Medicine, offers a unique and challenging insight into a reality of modern medicine (New England Journal of Medicine 2005;352: 959; Nederlands Tijdschrift Geneeskunde 2005;149: 183-8).

Verhagen asks, “If I have no techniques, no options to treat, if palliative care is not an option, what do I do? Do I send the child away, or really help it and hasten its death?

“We are not making this up. Horrible diseases do exist where a child is suffering unbearably but will not die immediately.”

Last autumn he attempted to make politicians in The Hague take notice by revealing that a joint local protocol had been drawn up by paediatricians and the public prosecution service in Groningen under which paediatricians who deliberately …