Dutch paediatricians have voted unanimously to adopt as national guidelines the so called Groningen protocol that covers the mercy killing of newborn babies who are incurably sick and are suffering severely. The Dutch Paediatric Society accepted that “in exceptional circumstances and under strict conditions… deliberate ending of life” of such newborns “can be an acceptable option.”
The protocol gives exact details of the requirements doctors must follow and includes the mandatory reporting of all cases. The local protocol drawn up at Groningen University Hospital last autumn caused an international outcry. Its clinical director of paediatrics, Eduard Verhagen, told the BMJ at the time, “It is time to be honest; all over the world doctors end lives discreetly, out of compassion” (BMJ 2005;330: 560).
The protocol, which the Groningen doctors agreed with the public prosecution service, enables doctors to report their actions without being prosecuted.
Its requirements include a clear diagnosis and prognosis; that the newborn baby must be suffering hopelessly and unbearably with no prospect for future treatment; that both parents must give their informed consent; that the decision must be confirmed by a second independent doctor; and that the death and treatment must be reported to the local coroner.
After the recent decision, Dr Verhagen, who chairs the society's ethics and law committee, said, “The society has agreed a clear and uniform approach to the decisions regarding deliberate life ending procedures in sick newborns.” The “confirmation of the acceptability” of this practice was an important step for parents and doctors.
It “underlines accountability,” Dr Verhagen said. “Dutch paediatricians have indicated their choice for a control mechanism based on self reporting and public review. They fully realise they themselves are the ones who need to report.”
The society now stresses the urgent need for a system of reporting, in the first instance to a national committee of doctors, lawyers, and ethicists rather than to the public prosecutor. Such a system already exists under the euthanasia law but the system excludes newborns as a request for euthanasia from the patient is required.
It believes that a system of reporting to a national committee rather than to the public prosecutor would encourage doctors to report their actions and thus ensure legal and societal control. It estimates that currently 15 cases occur each year in the Netherlands and that on average only three are reported. The cases are thought to be babies born with severe spina bifida, involving brain damage, and babies who suffer severe hypoxia at birth.
The society points out that last year the government promised proposals to improve the reporting of life ending decisions for newborns, while calling on the medical profession to take initiatives too. “That is what the society has now done. The ball is now with the politicians,” said Dr Verhagen.
Dutch opposition Labour MP and former health academic Godelieve van Heteren has now asked justice minister Piet Hein Donner in parliament if he supports the protocol. A health ministry spokeswoman said that she expects proposals for a national assessment committee to be drawn up by the Ministry of Justice after the summer.
Longer versions of these articles are on bmj.com