Dutch government intends to endorse guidelines on child euthanasia

Associated Press/TOBY STERLING | September 30 2005

AMSTERDAM, Netherlands - The Dutch government intends to expand its current euthanasia policy, setting guidelines for when doctors may end the lives of terminally ill newborns with the parents' consent.

A letter outlining the new directives will be submitted to parliament for discussion by mid-October, but the new policy will not require a vote or change of law, Dutch Health Ministry spokeswoman Annette Dijkstra told The Associated Press today.

The Netherlands became the first nation to legalize euthanasia for adults under some conditions in 2001, and the latest move is likely to spark an outcry from the Vatican, right-to-life proponents and advocacy groups for the handicapped.

Euthanasia is banned in most countries, although Belgium legalized it under strict conditions in 2002. Switzerland allows passive assistance to terminally ill people who have expressed a wish to die.

In the United States, Oregon is alone in allowing physician assisted suicide, but its law is under constant challenge and the U.S. Supreme Court is to hear arguments against it Wednesday.

The change in Dutch policy is especially significant because it will provide the model for how the country treats other cases in which patients are unable to say whether they want to live or die, such as those involving the mentally retarded or elderly people who have become demented.

The governing conservative Christian Democrat party - which fought legalization when it was in the opposition - will embrace the guidelines, known as the Groningen Protocol, drawn up last year by doctors at the Groningen University Medical Center.

Under the protocol, euthanasia would be permissible when a child is terminally ill with no prospect of recovery and suffering great pain, when two sets of doctors agree the situation is hopeless and when parents give their consent.

The Dutch Health Ministry has postponed this decision several times and wishes to control the release of information around the policy change, which is still being finalized.

But Dijkstra confirmed the broad lines of the guidelines after details began leaking to the Dutch press and to some members of the medical community who have been involved in the long-running debate over the issue.

The government will establish a vetting commission - modeled on commissions currently in place for adult euthanasia - to determine whether conditions have been met in each case and to refer the case to public prosecutors if they do not. But unlike with adult euthanasia, prosecutors will not be bound to follow the commission's judgment that conditions have been satisfied.

"The public prosecutor's office will always make an independent decision," Dijkstra said. "The ending of a life must occur with the utmost of caution."

American ethicist and pediatrician Dr. Chris Feudtner of the Children's Hospital of Philadelphia said he hoped the Dutch government would rethink its position.

"I admire the Dutch desire for openness in addressing what is an incredibly difficult issue, but I categorically do not endorse ending people's lives with the argument that it's alleviating their suffering," he told the AP.

"I think too often the impulse is to resort to extreme measures because we're not being effective enough in the management of pain."

He said removing life support is a possibility in cases parallel to that of coma patient Terri Schiavo, for instance if a child is born with just the stem of a brain. But active euthanasia is "prone to abuse," he said.

"If you allow it to occur, it will occur in cases where it is not ethical, period," he said.

The Netherlands set up adult euthanasia vetting commissions in 1998, well before the practice was formally legalized under a 2001 law, which took effect the following year.

The commissions report about 2,000 people are euthanized in this country of 16 million each year, using a mix of sedatives and a lethal dose of muscle relaxant. But independent studies suggest the number of unreported cases is higher.

Cases of euthanasia for "people with no free will" - such as infants and severely demented or retarded people - were left in a legal gray area by the law because they were so controversial.

They remain classified as murder, and doctors who carried out such killings were required to report themselves to the authorities for potential prosecution.

Government-sponsored studies in the 1990s and repeated in 2001 estimated there are 15 to 20 such infant killings in any year. Just 22 cases were reported to the Justice Ministry between 1997 and 2004 - most involving infants with severe damage to the brain and spine from spina bifida - and the ministry decided against prosecuting any of them.

The decision was based on precedents set when doctors were taken to court for euthanizing elderly patients and were either acquitted or found to have acted in good conscience. Judges ruled the level of guilt was so small it did not merit punishment.

The main author of the protocol, Dr. Eduard Verhagen, said it was intended to remove the confusion surrounding what is permissible.

"We think the decision is of such incredible importance that the social responsibility of the doctor should be openly discussed and assessed," he said.