Sir,
in their description of end-of-life decisions in newborns, as
practiced in the Netherlands,[1] A.A. Verhagen and P.J. Sauer state that
it should be permitted to actively end the life of an infant with hopeless
suffering that cannot be alleviated by any means. I agree. However, as
judged from a prior article the authors published this year in the New
England Journal of Medicine,[2] all infants put to death under the
Groningen protocol apparently had spina bifida. During the first months of
life, an infant with spina bifida wears diapers and is unable to sit,
stand or walk just as any other infant, and one wonders what suffering
this constitutes. Sure, long-term prospects for leading an independent
life may be grim, but ending such an infant´s life foremost ends the
sufferings of the caregivers and society at large. Ironically, this
specific society, as several others, is rather reluctant to engage in
folic acid fortification and fetal ultrasound screening programs.
An impression of hypocrisy is also invoked by the complaint about the
low rate of pediatricians involved in newborn euthanasia who actually
report these cases to the juridical system by informing the coroner. I
would not blame them. Under the system described, any such behaviour still
carries the risk of prosecution which might ruin the rest of the
physician´s life. Even when ultimately turned down a prosecution may
consume her or his mental and financial ressources for years. Although
this risk might be small (actually calculating it is hampered by the small
number of reported cases), it is bad advice to take that risk. Seen from
the outside, it appears quite phony that a society demands that a
pediatrician kills a newborn in order to stop suffering that cannot be
alleviated otherwise, without this society also taking formal
responsibility for this act prior to its execution. In an era where the
most innocuous clinical studies require prior approval by local ethical
committees, I wonder why the College of Attoneys General should not
consider a planned euthanasia beforehand, and, by approving it, also take
legal responsibility for it. In case of dissent, the minister of justice
would then have to take the College of Attorneys General to court, instead
of the executing physician. Such an approach would be more apt to meet the
goal of preventing uncontrolled and unjustified euthanasia.
[1] Verhagen AA, Sauer PJ. End-of-life decisions in newborns: An
approach from the Netherlands. Pediatrics 2005;116:736-739
[2]Verhagen AA, Sauer PJ. The Groningen protocol – euthanasia in
severly ill newborns. N Engl J Med 2005;352:959-962
Conflict of Interest:
None declared
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