Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 983-984 (doi:10.1542/peds.2005-2741)
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Neonatal Euthanasia? In Reply

A.A.E. Verhagen, MD, JD
P.J.J. Sauer, MD, PhD
Department of Pediatrics
Beatrix Children's Hospital
University Medical Center Groningen
9700 RB Groningen, Netherlands

In Reply.—

We thank Bondi et al for their response to our article on end-of-life decisions in newborns.1 The scope of our article was not to explore the ethical and moral implications of "newborn euthanasia." We have focused on the acceptability of end-of-life decisions in newborns and the importance of transparency in these decisions. We agree that the principle of autonomy is the backbone for the regulation of end-of-life decision-making in adolescents and adults. This principle was taken as the starting point of the legalization of euthanasia in the Netherlands. In addition, the principle of beneficence, encompassing the physician's duty to alleviate suffering, played an important role in the process of regulating termination of life in the Netherlands in both competent and incompetent patients.2 The Groningen Protocol was designed to support physicians and parents in the rare event that they must choose between prolonging the life of a newborn with hopeless and intractable severe suffering and the alleviation of symptoms by ending the newborn's life.

We agree with Bondi et al that the protocol can also be applied to older children, because the conflict of duties is not found exclusively in decisions regarding newborns. An open discussion about the scope and limits of "nonvoluntary euthanasia" is important. In our opinion, the obligatory reporting and public-expert review of the decision to actively end the life of a pediatric patient will contribute to this discussion. Experiences with expert review in euthanasia cases in adolescents and adults seem to support this view.3 We welcome additional discussion.

REFERENCES

  1. Verhagen AAE, Sauer PJJ. End-of-life decisions in newborns: an approach from the Netherlands. Pediatrics. 2005;116 :736 –739[Abstract/Free Full Text]
  2. Griffiths J, Bood A, Weyers H. The terms of debate since 1982. In: Euthanasia and the Law in the Netherlands. Amsterdam, Netherlands: Amsterdam University Press; 1998:157–196
  3. Widdershoven GA. Euthanasia in the Netherlands: experiences in a review committee. Med Law. 2004;23 :687 –91[Medline]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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Neonatal Euthanasia? In Reply
A.A.E. Verhagen and P.J.J. Sauer
Pediatrics 2006 117: 983-984. [Extract] [Full Text]  




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