The Groningen Protocol is a medical protocol created in September 2004 by

Eduard Verhagen Eduard Verhagen (born 3 May 1962, Haarlem) is an attorney and the medical director of the department of pediatrics at the University Medical Center Groningen (UMCG). He is mainly known for his involvement in infant euthanasia in the Netherlands. ...

, the medical director of the department of

pediatrics Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...

at the

University Medical Center Groningen The University Medical Center Groningen (UMCG, nl, Universitair Medisch Centrum Groningen), formerly Groningen University Hospital, is the main hospital in Groningen, Netherlands. The medical centre is affiliated with the University of Groninge ...

(UMCG) in

Groningen Groningen (; gos, Grunn or ) is the capital city and main municipality of Groningen province in the Netherlands. The ''capital of the north'', Groningen is the largest place as well as the economic and cultural centre of the northern part of t ...

, the Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" (

child euthanasia Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country to decriminalize euthanasia for infants with hopeless prognosis and int ...

) without fear of legal prosecution.

Origin

The protocol was created by a committee of physicians and others at the University Medical Center

, in consultation with the Groningen district attorney, and has been ratified by the Dutch National Association of Pediatricians. According to its authors, the Groningen Protocol was developed in order to assist with the decision making process when considering actively ending the life of a newborn, by providing the information required to assess the situation within a legal and medical framework. In July 2005 the Protocol was declared to be mandatory by the Dutch Society for Pediatrics.

Protocol

The protocol, drawn up after extensive consultation between physicians, lawyers, parents and the Prosecution Office, offers procedures and guidelines to achieve the correct decision and performance. The final decision about "active ending of life on infants" is ''not'' in the hands of the physicians but with the parents, with physicians and social workers agreeing to it. Criteria are, amongst others, "unbearable suffering" and "expected quality of life". Only the parents may initiate the procedure. The procedure is reported to be working well. For the Dutch public prosecutor, the termination of a child's life (under age 1) is acceptable if four requirements were properly fulfilled: #The presence of hopeless and unbearable suffering. #The consent of the parents to termination of life. #Medical consultation having taken place. #Careful execution of the termination. 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 review committee. The procedure differs in this respect from the

black letter law In common law legal systems, black letter laws are the well-established legal rules that are no longer subject to reasonable dispute. Some examples are the "black-letter law" that the formation of a contract requires consideration, or the "black- ...

governing voluntary euthanasia. There, the medical examiner sends the report only to the regional review committee, which alerts the district attorney only if it judges that the physician acted improperly.

Legal status

The Dutch euthanasia laws require people to ask for euthanasia themselves (

voluntary euthanasia Voluntary euthanasia (VE) is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years. Some forms of ...

), and it is legal for people of 12 years and older. In the

Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...

, euthanasia remains technically illegal for patients under the age of 12. The Groningen Protocol does not give physicians unassailable legal protection. 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.

Review

In 2005 a review study was undertaken of all 22 reported cases between 1997 and 2004. All cases concerned newborns with

spina bifida Spina bifida (Latin for 'split spine'; SB) is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, me ...

and

hydrocephalus Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased intracranial pressure, pressure inside the skull. Older people may have headaches, double vision, poor ...

. In all cases, at least 2 doctors were consulted outside the medical team. In 17 of 22 cases, a multidisciplinary spina bifida team was consulted. All parents consented to the termination of life; in 4 cases they explicitly requested it. The mean time between reporting of the case and the decision concerning prosecution was 5.3 months. None of the cases led to prosecution. The study concluded that all cases of active termination of life reported were found to be in accordance with good practice.

Reception

The protocol is controversial and has been attacked by anti-

euthanasia Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different eut ...

campaigner

Wesley J. Smith Wesley J. Smith (born 1949) is an American lawyer and author, a Senior Fellow at the Discovery Institute's Center on Human Exceptionalism, a politically conservative non-profit think tank. He is also a consultant for the Patients Rights Council. S ...

, Senior Fellow at the Discovery Institute, who described it as little more than an attempt to legalize

infanticide Infanticide (or infant homicide) is the intentional killing of infants or offspring. Infanticide was a widespread practice throughout human history that was mainly used to dispose of unwanted children, its main purpose is the prevention of reso ...

. Several studies have questioned the basis for the protocol and have recommended abandoning it; however,

bioethicist Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, med ...

Jacob M. Appel of

New York University New York University (NYU) is a private research university in New York City. Chartered in 1831 by the New York State Legislature, NYU was founded by a group of New Yorkers led by then-Secretary of the Treasury Albert Gallatin. In 1832, the ...

has said that the protocol is a success and should be expanded.

Hilde Lindemann Hilde Lindemann (also ''Hilde Lindemann Nelson'') is an American philosophy professor and bioethicist and emerita professor at Michigan State University. Lindemann earned her B.A. in German language and literature in 1969 at the University of Ge ...

and Marian Verkerk said that the policy must be evaluated in the context of Dutch culture and medicine, but Eric Kodish has harshly criticized the protocol and its premises in an article published in ''

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...

''. Kodish concluded by inviting resistance to the protocol by means of civil disobedience against the medical institutionalization of infanticide.

References