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Fritz Feds

Tuesday, November 30, 2004

The Netherlands jumps merrily all the way to the bottom of the slippery slope

I don't really have much to say about this Knight Ridder story about the Dutch policy of killing those children who are deemed unworthy of life. Just read it:

AMSTERDAM, Netherlands - Four times in recent months, Dutch doctors have pumped lethal doses of drugs into newborns they believe are terminally ill, setting off a new phase in a growing European debate over when, if ever, it's acceptable to hasten death for the critically ill.

Few details of the four newborns' deaths have been made public. Official investigations have found that the doctors made appropriate and professional decisions under an experimental policy allowing child euthanasia that's known as the Groningen University Hospital protocol.

But the children's deaths, and the possibility that the protocol will become standard practice throughout the Netherlands, have sparked heated discussion about whether the idea of assisting adults who seek to die should ever be applied to children and others who are incapable of making, or understanding, such a request.

"Applying euthanasia to children is another step down the slope in this debate," said Henk Jochemsen, the director of Holland's Lindeboom Institute, which studies medical ethics. "Not everybody agrees, obviously, but when we broaden the application from those who actively and repeatedly seek to end their lives to those for whom someone else determines death is a better option, we are treading in dangerous territory."

The Dutch debate is being closely watched throughout the continent. Belgium has laws similar to those in the Netherlands, and a bill permitting child euthanasia is before its Parliament. No date has been set for debate.

Great Britain is considering legalizing assisted suicide for the terminally ill, amid reports that doctors already may be helping thousands of patients to die each year.

"Assisted dying is a fact," said Hazel Biggs, the director of medical law at the University of Kent, who's about to publish a report estimating the number of assisted deaths in Britain at 18,000 annually. "We have to regulate it, to ensure that vulnerable people are being protected."

Under the Groningen protocol, if doctors at the hospital think a child is suffering unbearably from a terminal condition, they have the authority to end the child's life. The protocol is likely to be used primarily for newborns, but it covers any child up to age 12.

The hospital, beyond confirming the protocol in general terms, refused to discuss its details.

"It is for very sad cases," said a hospital spokesman, who declined to be identified. "After years of discussions, we made our own protocol to cover the small number of infants born with such severe disabilities that doctors can see they have extreme pain and no hope for life. Our estimate is that it will not be used but 10 to 15 times a year."

A parent's role is limited under the protocol. While experts and critics familiar with the policy said a parent's wishes to let a child live or die naturally most likely would be considered, they note that the decision must be professional, so rests with doctors.

The protocol was written by hospital doctors and officials, with help from Dutch prosecutors. It's being studied by lawmakers as potential law.

Under the protocol, assisted infant deaths are investigated, but so far all of them have been determined to have been in the patients' best interests.

Euthanasia has been legal in the Netherlands since 1994. Under the law, any critically ill patient older than 12 can request an assisted death, including adults in the early stages of dementia.

The law doesn't allow involuntary euthanasia nor does it apply to children younger than 12, who aren't considered aware enough to make a life-or-death choice.

Dutch doctors have some intentional role in 3.4 percent of all deaths, according to statistics published in the medical journal The Lancet. About 0.6 percent are patients who didn't ask to be euthanized, the journal said.

Dutch courts often treat those cases leniently if an investigation determines that the doctor acted out of concern for the patient's well-being.

Opponents of expanding euthanasia to the young cite a recent Dutch court ruling against punishment for a doctor who injected fatal drugs into an elderly woman after she told him she didn't want to die.

The court determined that he'd made "an error of judgment," but had acted "honorably and according to conscience."

News reports say that since that decision some elderly hospital patients are carrying written appeals not to be euthanized. A German company has proposed a nursing home just across the border from the Netherlands that would be promoted to aging Dutch residents as a safe haven in a country where euthanasia is illegal and likely to remain so.

What happens to vulnerable people is a particularly sharp issue in a continent where birthrates have declined, populations have aged and five nations have more old than young. Euthanasia opponents fear that as costs increase for long-term intensive care and health-care budgets become more strained, financial reasons could creep into euthanasia debates.

"The danger, of course, is ensuring a debate on the right to die does not become one on a duty to die,"
said Urban Wiesing, the chair for ethics in medicine at Germany's prestigious Eberhard Karls Tuebingen University.

The issue is a particularly delicate one in Germany, where euthanasia was used by the Nazis as cover for wide-scale murders of the disabled, among others. Germany is one of the few countries where there's no serious push to legalize assisted suicide.

If this doesn't chill you to the bone, I'm not sure what I can add.


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