Pulling Back the Curtain on the Mercy
Killing of Newborns
An ethics expert urges us to think twice before decrying Dutch doctors' report.
Los Angeles Times March 11, 2005 By Peter Singer
(Professor of bioethics, Princeton University; author of "Rethinking Life
and Death: The Collapse of Our Traditional Ethics" (St. Martin's Press, 1994).
In Thursday's New England Journal of Medicine, two doctors from the University
Medical Center Groningen in the Netherlands outline the circumstances in which
doctors in their hospital have, in 22 cases over seven years, carried out euthanasia
on newborn infants. All of these cases were reported to a district attorney's
office in the Netherlands. None of the doctors were prosecuted.
Eduard Verhagen and Pieter Sauer divide into three groups the newborns for whom
decisions about ending life might be made.
The first consists of infants who would die soon after birth even if all existing
medical resources were employed to prolong their lives.
In the second group are infants who require intensive care, such as a respirator,
to keep them alive, and for whom the expectations regarding their future are "very
grim." These are infants with severe brain damage. If they can survive beyond
intensive care, they will still have a very poor quality of life.
The third group includes infants with a "hopeless prognosis" and who
also are victims of "unbearable suffering." For example, in the third
group was "a child with the most serious form of spina bifida," the
failure of the spinal cord to form and close properly. Yet infants in group three
may no longer be dependent on intensive care.
It is this third group that creates the controversy because their lives cannot
be ended simply by withdrawing intensive care. Instead, at the University Medical
Center Groningen, if suffering cannot be relieved and no improvement can be expected,
the physicians will discuss with the parents whether this is a case in which death
"would be more humane than continued life." If the parents agree that
this is the case, and the team of physicians also agrees — as well as an
independent physician not otherwise associated with the patient — the infant's
life may be ended.
American "pro-life" groups will no doubt say that this is just another
example of the slippery slope that the Netherlands began to slide down once it
permitted voluntary euthanasia 20 years ago. But before they begin denouncing
the Groningen doctors, they should take a look at what is happening in the United
States.
One thing is undisputed: Infants with severe problems are allowed to die in the
U.S. These are infants in the first two of the three groups identified by Verhagen
and Sauer. Some of them — those in the second group — can live for many
years if intensive care is continued. Nevertheless, U.S. doctors, usually in consultation
with parents, make decisions to withdraw intensive care. This happens openly,
in Catholic as well as non-Catholic hospitals.
I have taken my Princeton students to St. Peter's University Hospital, a Catholic
facility in New Brunswick, N.J., that has a major neonatal intensive care unit,
where Dr. Mark Hiatt, the unit director, has described cases in which he has withdrawn
intensive care from infants with severe brain damage.
Among neonatologists in the U.S. and the Netherlands, there is widespread agreement
that sometimes it is ethically acceptable to end the life of a newborn infant
with severe medical problems. Even the Roman Catholic Church accepts that it is
not always required to use "extraordinary" means of life support and
that a respirator can be considered "extraordinary."
The only serious dispute is whether it is acceptable to end the life of infants
in Verhagen and Sauer's third group, that is, infants who are no longer dependent
on intensive care for survival. To put this another way: The dispute is no longer
about whether it is justifiable to end an infant's life if it won't be worth living
but whether that end may be brought about by active means, or only by the withdrawal
of treatment.
I believe the Groningen protocol to be based on the sound ethical perception that
the means by which death occurs is less significant, ethically, than the decision
that it is better that an infant's life should end. If it is sometimes acceptable
to end the lives of infants in group two — and virtually no one denies this
— then it is also sometimes acceptable to end the lives of infants in group
three.
And, on the basis of comments made to me by some physicians, I am sure that the
lives of infants in group three are sometimes ended in the U.S. But this is never
reported or publicly discussed, for fear of prosecution. That means that standards
governing when such actions are justified cannot be appropriately debated, let
alone agreed upon.
In the Netherlands, on the other hand, as Verhagen and Sauer write, "obligatory
reporting with the aid of a protocol and subsequent assessment of euthanasia in
newborns help us to clarify the decision-making process." There are many
who will think that the existence of 22 cases of infant euthanasia over seven
years at one hospital in the Netherlands shows that it is a society that has less
respect for human life than the United States. But I'd suggest that they take
a look at the difference in infant mortality rates between the two countries.
The CIA World Factbook shows that the U.S. has an infant mortality rate of 6.63
per 1,000 live births, the Netherlands 5.11. If the U.S. had infant mortality
rates as low as the Netherlands, there would be 6,296 fewer infant deaths nationwide
each year.
Building a healthcare system in the U.S. as good as that in the Netherlands —
as measured by infant mortality — is far more worthy of the attention of
those who value human life than the deaths of 22 tragically afflicted infants.
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Copyright 2005 Los Angeles Times