The Groningen Protocol: Medical License to Kill

Published in The Indicator, vol. XIX, February 10, 2005
by Elizabeth Petrik

Netherlands infant euthanasia policy is a symptom of a deeper, more widespread moral ailment.
So act as to treat humanity, whether in thine own person or in that of any other, in every case as an end in itself, never as means only. Immanuel Kant

Curiously few people have heard of the Groningen Protocol, and still fewer are as outraged as they should be. The media seems to have taken little interest in what has been described as “a radical leap past Kevorkian land into the regions of Mengele.” Put simply, the Groningen Protocol is a Dutch hospital’s experimental policy that establishes a panel of doctors to determine whether “highly defective” infants should be euthanized.

The Grand Forks Herald broke the story in October 2004, reporting: “The protocol is likely to be used primarily for newborns, but it covers any child up to age 12,” (the age at which the Netherlands allows dying children to request assisted suicide).” Also, the journal added, “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 [would probably] be considered, they note that the decision must be professional, so rests with doctors.”

Although the proposal has yet to be officially instated by the Dutch Health Ministry, Groningen Hospital has already put it to test: four infants were quietly killed last year behind the hospital’s walls.

Frighteningly, such policies show signs of spreading beyond the Dutch borders. Belgium’s Parliament is also considering a law allowing infant euthanasia, and it is speculated that British physicians illegally euthanize as many as 18,000 child and adult patients per year. In the America, only the state of Oregon permits assisted suicide; non-consensual euthanasia, except for the cessation of treatment, is not legal in the States. Yet even here, deliberately administering overdoses of sedatives or painkillers is probably not uncommon and in some cases may be done without the patient’s consent. “As things are, people are doing this secretly, and that’s wrong,” affirms the head of Groningen’s children’s clinic Eduard Verhagen. The issue clearly needs to be addressed by government. Making these practices legal, however, to allow them to “be subjected to vetting” as Verhagen proposes, is not the solution.

Granted, the Groningen Protocol is only meant to apply to “very sad cases…the small number of infants born with such severe disabilities that doctors can see they have extreme pain and no hope for life,” as one spokesman for the hospital insisted. These tragic cases would include extremely premature infants and children with severe spina bifida or hydrocephalus. They might be missing parts of their body or brain, be severely handicapped (mentally and/or physically), or have no hope of surviving off life support. It is easy to see how doctors who encounter such broken and suffering specimens of humanity would be moved by compassion to dispatch these infants as humanely as possible.

Unfortunately, even the best of intentions can lead to misguided actions. As radio talk show host Hugh Hewitt points out, “The establishment of ‘independent committees’ to dispatch non-consenting humans is nothing but a death penalty committee for innocents. Once begun, it is impossible—simply impossible—to limit the concept with any bright line.”

When people take into their own hands the lives of those “with no free will,” there is no logical stopping point, no boundary of circumstances beyond which it would be unreasonable to destroy such a life. Euthanasia of children who have a .1% chance of surviving without life support leads naturally to euthanasia of children with a 10% chance. A still more cynical possibility: in a socialized medical system like the Netherlands’, this government-sponsored euthanasia panel might be tempted to annihilate any children whose treatments are not found cost-effective.

The protocol’s potential drift toward becoming a permission slip for convenient murder is horrible to contemplate. Nevertheless, the world must recognize that Groningen has already hit the bottom of the proverbial slippery slope. The Groningen Protocol and its widespread acceptance—or at least tacit endorsement—reveal a deeply distorted outlook on human life. By counting supposed “normal” or “good” lives as worthwhile and the rest only fit for merciful termination, this policy takes for granted that the value of an infant lies solely in the amount of pleasure and meaning its existence can contain. This idea is completely contrary to the human dignity euthanasia advocates claim to defend. From this utilitarian standpoint, the birth of a child is not miraculous and the saving of a life is not an inherent good. Humans are regarded as mere shells without intrinsic value; the worth of their existence is determined by its quality alone. This is the position Groningen Hospital adopted when it took the lives of those four infants and the position the world takes by condoning their killings.

Some advocates of infant euthanasia, however, hold that a newborn, as a non-rational being incapable even of desiring to live or to die, is still below the level of humanity. It should be treated more like an animal: if it is suffering unbearably, put it out of its misery. This raises the question: should human DNA automatically accord its bearer the “unalienable rights” with which all men are endowed? Does a human in an apparently irreversible coma still have the right to life? What about a child who will probably die within a week of being born? A profoundly mentally handicapped adult? A fetus?

Even without invoking the sanctity of life I believe to be the truly central issue, it is possible to find a rigid moral standard to answer these questions. Philosopher H.T. Engelhardt Jr., for instance, argues that since it is difficult to find a bright line defining when a human becomes a person, people should be divided into “persons strictly, who are bearers of both rights and duties,” and persons socially, who “are not morally responsible agents, but are treated with respect.” This division has multiple advantages. Nearly all the gray area of personhood would be eliminated if all biological humans were treated—at least medically—as persons. This guideline would also prevent egregious errors, such as euthanasia of the wrongly diagnosed and mistreatment of those whose personhood is in doubt. For example, thanks to medical technology of the last half century, we can still recognize the virtually immobile Stephen Hawking as a thinking, feeling human being. Who knows how many sound minds future medical progress will discover in ruined bodies—say, in Terri Schiavo’s? In addition, a society in which all infirm people are cared for is a safer and better place for all people than one that tries to make fine distinctions between who is worthy of life and who is not. Above all, what reason does Groningen hospital have to believe that a committee of doctors is more qualified to make decisions about the value of a child’s life than the child’s own parents?

Almost everyone would agree that if a doctor thought an infant should be euthanized while the parents wanted to give it a chance, the final decision should rest with the parents. The possibility of a child being killed against his parents’ will is the most viscerally repulsive aspect of the Groningen Protocol. It smacks of Nazi Germany, eugenic extremism, and every shade of utopias-gone-wrong. Certainly a parent’s wish to let his child live should be respected at all costs. But is it truly less evil if it is the parents’ choice to terminate their offspring’s life? As far as the infant is concerned, the outcome is the same. Are the parents’ or the child’s rights truly more at stake under the Groningen Protocol? If the answer is the former, then it follows that parents should have the ultimate authority over their child’s life. On the contrary, however, infanticide of healthy children is roundly, and rightly, condemned. Therefore, it appears that even a newborn has a right to life independent of the emotional attachment of his parents. At what point then, is an infant so disabled that its parents have the right to step in and end its existence? Since the child is not capable of deciding for itself whether it wishes to continue living, shouldn’t it be given the benefit of the doubt, at least as a person in Engelhardt’s “social sense”? A parent’s love and empathy for his child could lead him to a decision that would alleviate his own suffering rather than promote the best interest of the infant.

This is where the issue of the inherent value of life arises. No one, not even the parents, can be sure of a newborn’s state of being. Perhaps in some primitive way, even the short amount of time they spend on earth is full of meaning and importance to them. Maybe their brief lives are holy to God. Or it could be that the world is a tormenting ordeal that they are glad to be rid of in the end. At any rate, until we know the answer to this question, we have no right to end the life of another human being. Modern medicine allows us to control suffering with painkillers, and in some cases it may be appropriate to deny a patient some potentially life-saving treatment if it seems too extreme for the bounds of human dignity. But causing death should never be the object of any medical procedure. All lives ought to be considered as valuable in and of themselves.

As horrifying as the Groningen Protocol is, we must recognize it as a natural consequence of our attitude toward life. From the institution of capital punishment at almost the dawn of civilization to the comparatively recent social acceptability of abortion, society has come to see human lives as dispensable when they do not appear to contribute anything good to the world. Until we recognize our mistake, policies like Groningen’s will have no trouble finding a moral foothold anywhere in our world.