Why the Groningen Protocol Should Be Rejected (Infant Euthanasia) (Essay‪)‬

Last year, in two widely discussed articles, Eduard Verhagen and Pieter Sauer reported on the Dutch experience with euthanasia in newborns under current Dutch law and medical practice and proposed a protocol, called the Groningen Protocol, to guide the decision-making. (1) The protocol has two parts. The first addresses "requirements that must be fulfilled," including diagnosis and prognosis that are "certain," presence of "hopeless and unbearable suffering," and confirmation of the diagnosis and prognosis by an independent physician. The second addresses "information needed to support and clarify the decision about euthanasia" that covers five domains: diagnosis and prognosis, "euthanasia decision," consultation, implementation, and "steps taken after death." Verhagen and Sauer also present a medical and legal justification for the protocol and clinical practice based upon it, and they develop this justification by referring to twenty-two cases of disabled newborns, all but one of them diagnosed with spina bifida. (2) The justification they offer is woefully inadequate, however. It relies on appeals to the concepts of "hopeless and unbearable suffering," the "best interests of the patient," and "medical-ethical values," (3) but it never explains these concepts, and it gives no ethical argument for their clinical application. (4) In fact, not only is no argument for the Protocol given, none can hope to succeed. The Groningen Protocol should therefore be rejected as the basis for obstetric and neonatal practice in The Netherlands and throughout the world.