The Dutch Paediatric Association (Nederlandse Vereniging voor Kindergeneeskunde) rejects the international criticism, arguing that some foreign doctors are rather too inclined to regard the provision of treatment as a goal in itself.
The criticism, however, has not all come from abroad. In fact it was Dutch paediatric neurosurgeon Rob de Jong who launched the current debate with an article published in the same journal. He has the support of other neurosurgeons from 12 countries in his efforts against the practice of euthanasia in the Netherlands on some babies born with this abnormality. Each year, the lives of a small number of babies are terminated by doctors who, together with the parents, believe the infant is experiencing unbearable suffering and will continue to suffer in this way in the future.
Meningomyelocele: protrusion of meningeal and spinal cord tissue through a bony defect in the vertebral column. |
In his article 'Deliberate termination of life of newborns with spina bifida, a critical reappraisal', Dr de Jong bases his case on medical arguments, not on ethical grounds such as those which have normally been at the centre of nearly all discussions about euthanasia. For example, in his article, Dr de Jong cites a number of cases of physicians who, in retrospect, have been forced to acknowledge that their initial diagnosis was incorrect. A South African doctor once sent a child with spina bifida away, saying that there was no point in operating on the infant as he believed that the child would soon die of natural causes. Years later it turned out that the child he had sent away was still alive and leading a reasonably independent life.
Criticism
The Dutch Paediatric Association does not share the criticism expressed by Dr de Jong and his foreign colleagues. Spokesman Eduard Verhagen says they use too many technical arguments, adding that what they actually saying is "If it's possible to give treatment, then you must indeed provide treatment."
But Mr Verhagen says that that the principle adhered to in the Netherlands when euthanasia is being considered is different. He argues that there must be a point to the treatment, and it must also be in the interest of the patient. He explains that treatment should not be given just because it's technically possible to do so; there must also be some hope of improvement as a result of that treatment. When that is not the case, then treatment should not be given, and the doctor together with the parents may consider - provided the patient is also experiencing unbearable suffering - whether it would be better to terminate the patient's life.
Dr Verhagen was one of the people who drafted what is now known as the Groningen Protocol, which sets out the conditions for the active termination of life, in other words, the performance of euthanasia on babies and infants. These conditions are as follows:
- the diagnosis and prognosis must be certain
- hopeless and unbearable suffering must be present
- the diagnosis, prognosis and unbearable suffering must be confirmed by at least one independent doctor
- both parents must give informed consent
- the procedure must be performed in accordance with the accepted medical standard
However, Dr de Jong and his supporters are also critical of the protocol. They argue that it is difficult to prove that the suffering of a baby or infant is or will remain unbearable, hence such a medical diagnosis/prognosis cannot be given with the requisite certainty.
Eduard Verhagen, himself a paediatrician and lawyer, believes that this argument relies on too narrow an interpretation of the protocol. He says that factors other than the suffering of the child and the possible treatment must also be taken into consideration. For example, the life expectancy of the parents should also be weighed.
'A storm in a teacup'
Dr Verhagen says these factors were looked at in depth when drawing up the protocol and, at this time, he sees no reason why the entire discussion should be repeated:
"We spoke about this extensively at the time. Now, some people want to conduct the debate once again on the basis of the same arguments as those involved in 2004. But nothing has changed since then. I assume, therefore, that this is a storm in a teacup."
One aspect worthy of note is that since the rules and conditions for this kind of euthanasia were set down on paper in 2004, there have been - according to Dr Verhagen - no further cases of euthanasia being performed on an infant with spina bifida. Research carried out in 2004 showed that 22 cases of euthanasia on babies were reported to the judicial authorities between 1997 and 2004. In all of those cases, the infant had a severe form of spina bifida.
* RNW translation (tpf)
Tags: euthanasia, meningomyelocele, paediatrics, spina bifida