Hastings Center Rep.: Ending the Life of a Newborn: The Groningen Protocol.

• Author: Lindemann, Hilde
• Position: Reprint

Since its publication in 2005, the Groningen Protocol has been under fire both in the Netherlands and outside it. The purpose of the protocol is to set a standard of practice for doctors to end the lives of severely impaired newborns, but it also lays out procedures for reporting doctors' decisions to authorities. 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 recently created review committee.

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 National Association of Pediatricians. 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.

The protocol has been criticized in various ways: (1) it is aimed primarily at babies with spina bifida, many of whom could lead satisfactory lives; (2) it fails to distinguish with clinical precision between babies whose prognosis of death is certain and those who could continue to live; (3) it allows parents to commit infanticide as a means of escaping an unwanted burden of care; (4) it lets doctors decide what is an acceptable quality of life; (5) it lets doctors determine the morality of their own actions; (6) it provides a purely procedural response to the problem of measuring subjective suffering; (7) it condones infanticide rather than preventing spina bifida or promoting its early detection via fetal ultrasound, followed by abortion; and (8) it offers an incoherent criterion for deciding whether to end an infant's life--it requires that the infant experience "hopeless and unbearable suffering."

The protocol applies to three categories of newborns for whom doctors must make end-of-life decisions. Group one consists of newborns with no chance of survival. Typically they have a fatal disease such as severe lung or kidney hypoplasia, and they are put on life support immediately after birth while their physicians determine the extent of the "damage." When the futility of treatment is apparent, the life support is removed so that the child can die. The decision to withhold or withdraw treatment from these infants is acceptable for physicians in Europe as well as the United States. If the baby does not die immediately after life support is withdrawn, deliberate ending of...