SHOCK: Newborns Who Suffer are "Better off Dead" - "World's Most Prestigious" Bioethics Journal

By John Jalsevac

GARRISON, NY, February 22, 2008 ( - In 2005 the world was horrified when it was revealed that in the Netherlands doctors were not only openly admitting that they had killed disabled newborn infants, but that the medical institution was actively promoting child euthanasia through the so-called Groningen Protocol. The protocol - the full name of which is The Groningen Protocol for Euthanasia in Newborns - lays out a set of guidelines that must be followed in making and executing the decision to kill a newborn infant.

The revelation that newborn euthanasia was both common and acceptable in the Netherlands was greeted with harsh criticisms from around the world, with one Italian Minister going to far as to accuse the Netherlands of Nazism. Others expressed their disgust that many of the children who were being euthanized by Dutch doctors were children with Spina Bifida, a condition with which many people have lived well into adulthood and had fulfilling lives.

A lengthy report that appears in the most recent issue of The Hastings Center Report - called by conservative bioethicist Wesley Smith the "world's most prestigious" journal of bioethics - however, strongly defends The Groningen Protocol as humane and perfectly ethical. It especially defends the ethical nature of the protocol's provisions for killing newborns with conditions that would allow them to live for many years.

The article, entitled "Ending the Life of a Newborn", penned by a pair of bioethicists - Hilde Lindemann and Marian Verkerk - ostensibly sets out to clarify eight separate "misunderstandings" about The Groningen Protocol. In the process, the pair defies initial expectations by boldly and unapologetically pointing out that the protocol is in truth much more extreme than most of its critics believe it to be; the authors, however, argue that its extremity is in fact its true strength, the true evidence of its ethical nature.

As the authors explain, there are three classes of newborns that can be euthanized under the Groningen Protocol, including: 1) Those who have no chance of survival, 2) those who "may survive after a period of intensive treatment but expectations for their future are very grim;" and 3) those "who do not depend on technology for physiologic stability and whose suffering is severe, sustained, and cannot be alleviated."

Amongst the eight criticisms that Lindemann and Verkerk take on is the criticism that the protocol "fails to distinguish with clinical precision between babies whose prognosis of death is certain and those who would continue to live." This fact, however, the authors argue, is the whole point of the protocol, for "it is precisely those babies who could continue to live, but whose lives would be wretched in the extreme, who stand in most need of the interventions for which the protocol offers guidance."

In fact, the pair suggests, there are some babies who are born with painful abnormalities that, if allowed to live, would live well into adulthood - but they are the ones who should be euthanized. In these cases "the baby is judged to be better off dead than forced to endure the only kind of life it can ever have."

The conditions that would allow babies to be killed in these circumstances include: "progressive paralysis, complete lifelong dependency, and permanent inability to communicate in any way."

"The whole point of the protocol is to help physicians end the lives of newborns who are so severely afflicted that neither their dying nor their living should be prolonged. That being the case, the pertinent distinction is not between babies who will die and those who could live, but between babies for whom life-ending decisions should be made and those for whom such decisions cannot be morally justified. In bringing within its compass babies who are in no danger of dying - and, indeed, with proper care could live to adulthood - the protocol is even more radical than its critics supposed."

The authors take to task those critics of the protocol who have suggested that it would be more ethical to ensure that babies with disabilities are aborted in utero, rather than killing them after they are born. "The supposedly morally superior alternative [of abortion]…does not strike us as superior at all," they say. Instead, the authors write, the parents should wait until the child is born, when they can make a more informed decision about the chance that their child has of living a "satisfactory" life. "We join disability activists who condemn the routine recommendation of abortions performed for no other reason than to prevent the birth of an affected baby."

It would be wiser, they suggest, to kill the child after it is born, if it is then determined to have poor prospects of a "satisfactory" life, than to hide behind the false moral justification of killing the disabled child in utero. Lindemann and Verkerk also clarify that in order for a newborn child to be killed by a physician, it is not necessary for the child to be suffering in the present, but physician and parents can make the choice to kill a newborn based upon a judgment of suffering in the future. "The protocol has been taken to apply not only to pain, but also to other kinds of serious and unrelievable conditions…The protocol thus leaves room for cases in which the suffering will take place in the future."

Once again the authors argue that the radical and far-reaching nature of the protocol is in fact a sign of its ethical superiority, saying "This forward-looking feature of the protocol is justified on the grounds that it is inhumane to keep a baby alive until it begins to experience intolerable suffering."

The killing of newborns, whether for current or for future pain and suffering, is justified by the authors by "quality of life criteria". They observe that it is already true in the Netherlands, and indeed throughout much of the world, that quality of life judgments are frequently made by physicians and family members in deciding whether or not to continue treatment for an adult. "It is one of the harsh realities of twenty-first-century medicine that quality-of-life judgments must be made. What we must not do is pretend that we do not already make them, and that there is somehow something morally different about doing it for a newborn baby."

Lindemann and Verkerk conclude that because newborn children are born into such a caring society, that does everything it can to provide for its citizens, ending the life of those babies who will suffer is "the most caring response," clarifying that "the judgment must be made with fear and trembling."

"Concerning the larger question of whether the practice for which the protocol was developed can be morally justified, we think it can - in the Netherlands, at any rate. When a tragically impaired infant is born into a society that is hospitable to its children, offers universal access to decent health care, and promotes an ethos among its citizens whereby they look after each other as a matter of course, we believe that the doctor's ending the baby's life could be the best, most caring response."

Conservative bioethicist Wesley Smith has responded to the Hastings Center article both on his blog, and in an article printed by the Center for Bioethics and Culture Network, saying that he was "taken aback" at the article, which has firmly placed infanticide into the mainstream.

"It wasn't many years ago that almost everyone accepted that infanticide is intrinsically and inherently wrong," wrote Smith. "No more. With personhood theory and the 'quality of life' ethic increasingly permeating the highest levels of the medical and bioethical intelligentsia, we are moving toward a medical system in which babies are put down like dogs and killing is redefined as compassion.

"But bigotry is bigotry even if you spell it c.o.m.p.a.s.s.i.o.n. And to think, after World War II German doctors were hanged for doing precisely what is being promoted in the 'prestigious' Hastings Center Report."


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