Groningen Protocol

Last updated

The Groningen Protocol is a medical protocol created in September 2004 by Eduard Verhagen, the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG) in Groningen, the Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" (child euthanasia) without fear of legal prosecution. [1] [2] [3]

Contents

Origin

The protocol was created by a committee of physicians and others at the University Medical Center Groningen, in consultation with the Groningen district attorney, and has been ratified by the Dutch National Association of Pediatricians. [4]

According to its authors, the Groningen Protocol was developed to assist with the decision-making process when considering actively ending the life of a newborn, by providing the information required to assess the situation within a legal and medical framework. [5] In July 2005 the protocol was declared to be mandatory by the Dutch Society for Pediatrics. [6]

Protocol

The protocol, drawn up after extensive consultation between physicians, lawyers, parents and the Prosecution Office, offers procedures and guidelines to achieve the correct decision and performance. The final decision about "active ending of life on infants" is not in the hands of the physicians but with the parents, with physicians and social workers agreeing to it. Criteria are, amongst others, "unbearable suffering" and "expected quality of life". Only the parents may initiate the procedure. The procedure is reported to be working well. [7]

For the Dutch public prosecutor, the termination of a child's life (under age 1) is acceptable if four requirements were properly fulfilled:

  1. The presence of hopeless and unbearable suffering.
  2. The consent of the parents to termination of life.
  3. Medical consultation having taken place.
  4. Careful execution of the termination. [7]

Doctors who end the life of a baby must report the death to the local medical examiner, who in turn reports it to both the district attorney and to a review committee. The procedure differs in this respect from the black letter law governing voluntary euthanasia. There, the medical examiner sends the report only to the regional review committee, which alerts the district attorney only if it judges that the physician acted improperly.

The Dutch euthanasia laws require people to ask for euthanasia themselves (voluntary euthanasia), and it is legal for people of 12 years and older. In the Netherlands, euthanasia remains technically illegal for patients under the age of 12. The Groningen Protocol does not give physicians unassailable legal protection. Case law has so far protected physicians from prosecution as long as they act in accordance with the protocol, but no black-letter law exists in this area. [4] In April 2023 the Dutch parliament released a statement that an arrangement will be introduced for the termination of life of seriously ill and untreatable children aged 1 to 12. This arrangement follows some areas of the Groningen protocol: "It will concern children with such a serious illness or disorder that death is inevitable and the death of these children is expected in the foreseeable future." [8]

Review

In 2005 a review study was undertaken of all 22 reported cases between 1997 and 2004. [7] All cases concerned newborns with spina bifida and hydrocephalus. In all cases, at least 2 doctors were consulted outside the medical team. In 17 of 22 cases, a multidisciplinary spina bifida team was consulted. All parents consented to the termination of life; in 4 cases they explicitly requested it. The mean time between reporting of the case and the decision concerning prosecution was 5.3 months. None of the cases led to prosecution. The study concluded that all cases of active termination of life reported were found to be in accordance with good practice. [7]

Reception

The protocol is controversial and has been attacked by anti-euthanasia campaigner Wesley J. Smith, [9] Senior Fellow at the conservative think tank Discovery Institute, who described it as an attempt to legalize infanticide. [10]

Several studies have questioned the basis for the protocol and have recommended abandoning it; [11] [12] [13] however, bioethicist Jacob M. Appel of New York University has said that the protocol is a success and should be expanded. [14] Hilde Lindemann and Marian Verkerk said that the policy must be evaluated in the context of Dutch culture and medicine, [15] but Eric Kodish has harshly criticized the protocol and its premises in an article published in The Lancet . Kodish concluded by inviting resistance to the protocol by means of civil disobedience against the medical institutionalization of infanticide. [3]

See also

Related Research Articles

Euthanasia is the practice of intentionally ending life to eliminate pain and suffering.

Paralysis is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling in the affected area if there is sensory damage. In the United States, roughly 1 in 50 people have been diagnosed with some form of permanent or transient paralysis. The word "paralysis" derives from the Greek παράλυσις, meaning "disabling of the nerves" from παρά (para) meaning "beside, by" and λύσις (lysis) meaning "making loose". A paralysis accompanied by involuntary tremors is usually called "palsy".

<span class="mw-page-title-main">Assisted suicide</span> Suicide undertaken with aid from another person

Assisted suicide means a procedure in which people take medications to end their own lives with the help of others, usually medical professionals. The term usually refers to physician-assisted suicide (PAS), which is an end of life measure for a person suffering a painful, terminal illness. Once it is determined that the person's situation qualifies under the physician-assisted suicide laws for that location, the physician's assistance is usually limited to writing a prescription for a lethal dose of drugs.

<span class="mw-page-title-main">Spina bifida</span> Birth defect of the spinal cord

Spina bifida is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, meningocele and myelomeningocele. Meningocele and myelomeningocele may be grouped as spina bifida cystica. The most common location is the lower back, but in rare cases it may be in the middle back or neck.

Utilitarian bioethics refers to the branch of bioethics that incorporates principles of utilitarianism to directing practices and resources where they will have the most usefulness and highest likelihood to produce happiness, in regards to medicine, health, and medical or biological research.

The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of the right to die is often bestowed with the understanding that a person with a terminal illness, incurable pain, or without the will to continue living should be allowed to end their own life, use assisted suicide, or decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

Eduard Verhagen is an attorney and the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG). He is mainly known for his involvement in infant euthanasia in the Netherlands.

Voluntary euthanasia is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years. Some forms of voluntary euthanasia are legal in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain.

<span class="mw-page-title-main">Mees' lines</span> Clinical sign involving white bands across the nails

Mees' lines or Aldrich–Mees lines, also called leukonychia striata, are white lines of discoloration across the nails of the fingers and toes (leukonychia).

John Lorber (1915–1996) was a professor of paediatrics at the University of Sheffield from 1979 until his retirement in 1981. He worked at the Children's Hospital of Sheffield, where he specialized in work on spina bifida. He also wrote on the subject of medical ethics regarding the use of intensive medical intervention for severely handicapped infants.

Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" which was passed in 2001 and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering, the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.

Involuntary euthanasia is illegal in all 50 states of the United States. Assisted suicide is legal in 10 jurisdictions in the US: Washington, D.C. and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. The status of assisted suicide is disputed in Montana, though currently authorized per the Montana Supreme Court's ruling in Baxter v. Montana that "nothing in Montana Supreme Court precedent or Montana statutes [indicates] that physician aid in dying is against public policy."

Non-voluntary euthanasia is euthanasia conducted when the explicit consent of the individual concerned is unavailable, such as when the person is in a persistent vegetative state, or in the case of young children. It contrasts with involuntary euthanasia, when euthanasia is performed against the will of the patient.

<span class="mw-page-title-main">Legality of euthanasia</span>

The legality of euthanasia varies between countries and territories. Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met with limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most advocacy organisations although medical associations express a range of perspectives, and supporters of palliative care broadly oppose euthanasia.

Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country since the end of Nazi Germany to decriminalize euthanasia for infants with hopeless prognosis and intractable pain. Nine years later, Belgium amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. Like euthanasia, there is world-wide public controversy and ethical debate over the moral, philosophical and religious issues of child euthanasia.

Both Euthanasia and Assisted Suicide are illegal in the United Kingdom and could be prosecuted as murder or manslaughter.

Terminal dehydration is dehydration to the point of death. Some scholars make a distinction between "terminal dehydration" and "termination by dehydration". Courts in the United States generally do not recognize prisoners as having a right to die by voluntary dehydration, since they view it as suicide.

Critics of euthanasia sometimes claim that legalizing any form of the practice will lead to a slippery slope effect, resulting eventually in non-voluntary or even involuntary euthanasia. The slippery slope argument has been present in the euthanasia debate since at least the 1930s.

"After-Birth Abortion: Why Should the Baby Live?" is a controversial article published by Francesca Minerva and Alberto Giubilini. Available online from 2012 and published in the Journal of Medical Ethics in 2013, it argues to call child euthanasia "after-birth abortion" and highlights similarities between abortion and euthanasia.

Baby M was the pseudonym of an Australian girl named Allison who was born with severe birth defects, whose treatment and eventual death caused significant controversy and international discussion about the medical ethics of disabled newborns. Right to Life activists accused her parents and the hospital of murdering the infant, leading to a lengthy legal inquest.

References

Notes

  1. ↑ Paediatricians call for nationwide protocol for the ending of life of unbearably and incurably suffering newborns – 10 December 2004
  2. ↑ Murder or health care: the Groningen Protocol Archived 2010-09-21 at the Wayback Machine
  3. 1 2 Kodish, Eric (2008). "Paediatric ethics: a repudiation of the Groningen protocol". The Lancet. 371 (9616): 892–893. doi:10.1016/S0140-6736(08)60402-X. PMID   18348350. S2CID   28268753.
  4. 1 2 "Ending the Life of a Newborn: The Groningen Protocol,: Introduction". www.medscape.com. Retrieved 2009-11-03.
  5. ↑ Verhagen E, Sauer PJ (March 2005). "The Groningen protocol—euthanasia in severely ill newborns". N. Engl. J. Med. 352 (10): 959–62. doi: 10.1056/NEJMp058026 . PMID   15758003.
  6. ↑ "Richtlijn Levensbeëindiging bij pasgeborenen, actieve".
  7. 1 2 3 4 Verhagen, AA.; Sol, JJ.; Brouwer, OF.; Sauer, PJ. (Jan 2005). "[Deliberate termination of life in newborns in The Netherlands; review of all 22 reported cases between 1997 and 2004]". Ned Tijdschr Geneeskd. 149 (4): 183–8. PMID   15702738.
  8. ↑ "Actieve levensbeëindiging mogelijk voor kinderen onder de 12 jaar". nos.nl. April 14, 2023.
  9. ↑ "Now They Want to Euthanize Children". The Weekly Standard. Archived from the original on January 5, 2013. Retrieved 2009-11-03.
  10. ↑ Smith, Wesley J. (March 2008). "Pushing Infanticide". National Right to Life News. Archived from the original on 23 June 2013. Retrieved 31 August 2012.
  11. ↑ Kompanje, EJ.; de Jong, TH.; Arts, WF.; Rotteveel, JJ. (Sep 2005). "[Questionable basis for 'hopeless and unbearable suffering' as the criterion for the active termination of life in newborns with spina bifida]". Ned Tijdschr Geneeskd. 149 (37): 2067–9. PMID   16184950.
  12. ↑ de Jong, TH. (Jan 2008). "Deliberate termination of life of newborns with spina bifida, a critical reappraisal". Childs Nerv Syst. 24 (1): 13–28, discussion 29–56. doi:10.1007/s00381-007-0478-3. PMC   2092440 . PMID   17929034.
  13. ↑ Kon AA (2007). "Neonatal euthanasia is unsupportable: the Groningen protocol should be abandoned". Theor Med Bioeth. 28 (5): 453–63. doi:10.1007/s11017-007-9047-8. PMID   17985108. S2CID   10188780.
  14. ↑ Appel, JM (May 5, 2009). "Neonatal Euthanasia: Why Require Parental Consent?". Journal of Bioethical Inquiry . 6 (4): 477–482. doi:10.1007/s11673-009-9156-3. S2CID   71929751.
  15. ↑ Lindemann, H.; Verkerk, M. (Mar–Apr 2008). "Ending the Life of a Newborn: The Groningen Protocol". Hastings Center Report . 38 (1): 42–51. doi:10.1353/hcr.2008.0010. PMID   18314809. S2CID   1284473.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.