Groningen Protocol
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The Groningen Protocol is a text 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 |
[edit] 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]
The Groningen Protocol was developed in order 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] The protocol, as suggested by Dr. E. Verhagen, was agreed upon by the Prosecutors Office in Groningen and in July 2005 declared mandatory by the Dutch Society for Pediatrics.[5]
[edit] Protocol
The protocol, made up after extensive consultation between physicians, lawyers, parents and the Prosecution Office, offers procedures and guidelines how 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 can start the procedure. The procedure is reported to be working well.[6]
For the Dutch public prosecutor, the termination of a child's life (under age 12) is acceptable if 4 requirements were properly fulfilled:
- The presence of hopeless and unbearable suffering
- The consent of the parents to termination of life
- Medical consultation having taken place
- Careful execution of the termination[6]
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.
[edit] Legal status
The Dutch euthanasia laws require people to ask for euthanasia themselves (voluntary euthanasia), and it is legal for people of 12 years and older. 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]
[edit] Review
In 2005 a review study was undertaken of all 22 reported cases between 1997 and 2004.[6] 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.[6]
[edit] Controversy
The protocol is controversial and has been attacked by anti-euthanasia campaigners like Wesley J. Smith.[7] Several studies have questioned the basis for the protocol.[8][9][10] and National Right to Life News described it as little more than an attempt to legalize infanticide.[11] Bioethicist Jacob M. Appel of New York University has said that the protocol is a success and should be expanded.[12] Hilde Lindemann and Marian Verkerk said that the policy must be evaluated in the context of Dutch culture and medicine.[13]
[edit] References
- ^ Paediatricians call for nationwide protocol for the ending of life of unbearably and incurably suffering newborns - 10 December 2004
- ^ Murder or health care: the Groningen Protocol
- ^ Kodish E (March 2008). "Paediatric ethics: a repudiation of the Groningen protocol". Lancet 371 (9616): 892–3. doi:10.1016/S0140-6736(08)60402-X. PMID 18348350.
- ^ a b "Ending the Life of a Newborn: The Groningen Protocol,: Introduction". www.medscape.com. http://www.medscape.com/viewarticle/569471. Retrieved 2009-11-03.
- ^ a b 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.
- ^ a b c d 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.
- ^ "Now They Want to Euthanize Children". www.weeklystandard.com. http://www.weeklystandard.com/Content/Public/Articles/000/000/004/616jszlg.asp. Retrieved 2009-11-03.
- ^ 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.
- ^ 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. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2092440.
- ^ 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.
- ^ Smith, Wesley J. (March 2008). "Pushing Infanticide". National Right to Life News. http://findarticles.com/p/articles/mi_6899/is_3_35/ai_n28537080/. Retrieved 1 July 2010.
- ^ Appel, JM (May 05, 2009). "Neonatal Euthanasia: Why Require Parental Consent?". Journal of Bioethical Inquiry 6 (4): 477–482. doi:10.1007/s11673-009-9156-3.
- ^ 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. http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=500.
[edit] Further reading
- Jotkowitz AB, Glick S (March 2006). "The Groningen protocol: another perspective". J Med Ethics 32 (3): 157–8. doi:10.1136/jme.2005.012476. PMC 2564470. PMID 16507660. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2564470.
- Manninen BA (November 2006). "A case for justified non‐voluntary active euthanasia: exploring the ethics of the Groningen Protocol". J Med Ethics 32 (11): 643–51. doi:10.1136/jme.2005.014845. PMC 2563300. PMID 17074822. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2563300.
