Groningen Protocol
Encyclopedia
The Groningen Protocol is a text created in September 2004 by Eduard Verhagen
, the medical director of the department of pediatrics
at the University Medical Center Groningen
(UMCG) in Groningen, The Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" (child euthanasia
) without fear of legal prosecution.
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. The protocol, as suggested by Dr. E. Verhagen, was agreed upon by the Prosecutors Office in Groningen and in July 2005 declared mandatory by the Dutch Society for Pediatrics.
For the Dutch public prosecutor, the termination of a child's life (under age 12) is acceptable if 4 requirements were properly fulfilled:
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
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.
), and it is legal for people of 12 years and older. 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.
and hydrocephalus
. 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.
. Several studies have questioned the basis for the protocol. and National Right to Life News
described it as little more than an attempt to legalize infanticide. Bioethicist Jacob M. Appel
of New York University has said that the protocol is a success and should be expanded. Hilde Lindemann and Marian Verkerk said that the policy must be evaluated in the context of Dutch culture and medicine.
Eduard Verhagen
Eduard Verhagen is an attorney and the medical director of the department of pediatrics at the University Medical Center Groningen . He is mainly known for his involvement in infant euthanasia in the Netherlands....
, the medical director of the department of pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
at the University Medical Center Groningen
University of Groningen
The University of Groningen , located in the city of Groningen, was founded in 1614. It is one of the oldest universities in the Netherlands as well as one of its largest. Since its inception more than 100,000 students have graduated...
(UMCG) in Groningen, The Netherlands. It contains directives with criteria under which physicians can perform "active ending of life on infants" (child euthanasia
Child euthanasia
Child euthanasia is a controversial form of non-voluntary euthanasia that is applied to children who are gravely ill or suffer from significant birth defects....
) without fear of legal prosecution.
Origin
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 Dutch National Association of Pediatricians.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. The protocol, as suggested by Dr. E. Verhagen, was agreed upon by the Prosecutors Office in Groningen and in July 2005 declared mandatory by the Dutch Society for Pediatrics.
Protocol
The protocol, made up after extensive consultation between physicians, lawyers, parents and the Prosecution Office, offers procedures and guidelines how 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 can start the procedure. The procedure is reported to be working well.For the Dutch public prosecutor, the termination of a child's life (under age 12) is acceptable if 4 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
Black letter law
The black letter law refers to the basic standard elements for a particular field of law, which are generally known and free from doubt or dispute...
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 euthanasiaVoluntary euthanasia
Voluntary euthanasia refers to the practice of ending a life in a painless manner...
), and it is legal for people of 12 years and older. 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 bifidaSpina bifida
Spina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through...
and hydrocephalus
Hydrocephalus
Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...
. 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.
Controversy
The protocol is controversial and has been attacked by anti-euthanasia campaigners like Wesley J. SmithWesley J. Smith
Wesley J. Smith is a lawyer and an award-winning author, a Senior Fellow at the Discovery Institute's Center on Human Exceptionalism. He is also a lawyer and consultant for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant for the Center for Bioethics and...
. Several studies have questioned the basis for the protocol. and National Right to Life News
National Right to Life Committee
The National Right to Life Committee is the oldest and largest pro-life organization in the United States with affiliates in all 50 states and over 3,000 local chapters nationwide. The group works through legislation and education to work against abortion, infanticide, euthanasia and assisted...
described it as little more than an attempt to legalize infanticide. Bioethicist Jacob M. Appel
Jacob M. Appel
Jacob M. Appel is an American author, bioethicist and social critic. He is best known for his short stories, his work as a playwright, and his writing in the fields of reproductive ethics, organ donation, neuroethics and euthanasia....
of New York University has said that the protocol is a success and should be expanded. Hilde Lindemann and Marian Verkerk said that the policy must be evaluated in the context of Dutch culture and medicine.