Neonatal Euthanasia and the Groningen Protocol

Abstract

Neonatal euthanasia has been legal in the Netherlands since 2005. Data indicate that neonatal euthanasia is practiced sub rosa by some clinicians in other countries as well; however, the true extent of neonatal euthanasia practice remains unknown. In this chapter, we review end-of-life options to describe the ethical background in the adult setting and how these translate into the neonatal setting. Further, the ethical arguments in favor and opposed to allowing euthanasia of infants, and those in favor and opposed to the use of paralytics in neonatal euthanasia, are presented.In 2002, experts in neonatology and bioethics from the University Medical Center Groningen, in collaboration with the Groningen district attorney's office, developed the Groningen Protocol that provides a systematic approach to decision-making regarding euthanizing infants (Verhagen and Sauer 2005a, b), which was adopted as a national guideline in 2005. The Protocol was spurred by data indicating that neonatal euthanasia was not uncommonly performed in The Netherlands (van der Heide et al. 1997); however, there were no standards for the practice. These findings raised significant concerns that some neonatologists may be euthanizing at least some infants without adequate oversight and without appropriate standards of practice.

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“…It is confusing to use the term “euthanasia” in this case because euthanasia usually involves a decision by the person to face death. The Protocol can be applied if the following conditions are fulfilled (Kon et al, 2022 ): (1) The diagnosis and prognosis must be certain; (2) Hopeless and unbearable suffering must be present; (3) The diagnosis, prognosis, and unbearable suffering must be confirmed by at least one independent doctor; (4) Both parents must give informed consent; and (5) The procedure must be performed in accordance with the accepted medical standard. Given the two first points, the Protocol is impossible to be applied.…”

“…On the other hand, Kon and colleagues define “unbearable suffering” as “subjective suffering to the extent that the patient herself feels that she can no longer bear it, and she believes that being dead would be better than being alive in her current state. That is, a degree of suffering that to the patient constitutes a fate worse than death” (Kon et al, 2022 , p. 292, footnote 2). It is unreasonable to think that a baby under 12 months could report “unbearable suffering” as defined here, so condition #2 is also impossible to fulfill.…”