Neonatal Euthanasia Research Articles

Dutch protocol from Groningen (the so-called Groningen Protocol). The problem of deliberate causing of death in newborns (“neonatal euthanasia”)

Problem eutanazji w panstwach, w ktorych ta procedura jest legalna dotyczy pacjentow zdolnych do podejmowania decyzji o swojej śmierci. Wyrazenie zgody na medycznie wspomagane przyspieszenie śmierci jest kluczowe. Inaczej natomiast wygląda sytuacja w przypadku osob, ktore nie mają zdolności do podejmowania decyzji, takim są np. pacjenci psychicznie chorzy, niepelnosprawni intelektualnie, pozbawieni świadomości czy bardzo male dzieci. W Holandii zostaly przyjete wytyczne dotyczące niemowląt, ktore są dotkniete nieuleczalną chorobą, tzw. Protokol z Groningen. Zapisy tego protokolu dotyczą zarowno rezygnacji z terapii, jak i czynnego przerwania zycia w postaci celowego spowodowania śmierci (eutanazji neonatalnej). Nalezy zaznaczyc, ze dokument ten nie jest wiązącym aktem prawnym. Powstają wątpliwości czy zapisy protokolu to jedynie dozwolona rezygnacja z terapii czy tez przyzwolenie na zabojstwo, ktore przy liberalnej polityce holenderskiej moze pozostac bezkarne. Pozostaje otwarte pytanie czy mamy do czynienia z aktem milosierdzia w postaci przerwania cierpien nieuleczalnie chorych pacjentow czy tez jest to wygodny pretekst do pozbycia sie nieuleczalnie chorych dzieci pod pozorem niskiej jakości ich zycia

Taking courage: Neonatal euthanasia and ethical leadership.

Taking courage: Neonatal euthanasia and ethical leadership.

Neonatal euthanasia: The Groningen Protocol.

For the past thirty years, voluntary euthanasia and physician-assisted suicide of adult patients have been common practice in the Netherlands. Neonatal euthanasia was recently legalized in the Netherlands and the Groningen Protocol (GP) was developed to regulate the practice. Supporters claim compliance with the GP criteria makes neonatal euthanasia ethically permissible. An examination of the criteria used by the Protocol to justify the euthanasia of seriously ill neonates reveals the criteria are not based on firm moral principles. The taking of the life of a seriously ill person is not the solution to the pain and suffering of the dying process. It is the role of the medical professional to care for the ailing patient with love and compassion, always preserving the person's dignity. Neonatal euthanasia is not ethically permissible.

Attitudes among the general Austrian population towards neonatal euthanasia: a survey.

BackgroundThe Groningen Protocol aims at providing guidance in end-of-life decision-making for severely impaired newborns. Since its publication in 2005 many bioethicists and health care professionals have written articles in response. However, only very little is known about the opinion among the general population on this subject. The aim of this study was to present the general attitude towards neonatal euthanasia (NE) among the Austrian population and the factors associated with the respondents’ opinion.MethodsA cross-sectional study was conducted among the general Austrian population. Computer-assisted telephone interviews were performed with 1,000 interviewees aged 16 years and older. Binary logistic regression was performed in order to determine factors that are independently associated with the respondents’ opinion about neonatal euthanasia.ResultsWhile 63.6% of the participants rejected the idea of neonatal euthanasia for severely impaired newborns, 36.4% opted either in favor or were undecided. Regression analysis has shown the respondents’ educational level (p = 0.005) and experience in the care of terminally ill persons (p = 0.001) to be factors that are positively associated with the rejection of neonatal euthanasia, whereas a higher age was associated with a lower degree of rejection (p = 0.021).ConclusionsWe found that the majority of the Austrian population rejects the idea of neonatal euthanasia for severely impaired newborns. However, given the increasing levels of rejection of NE among the younger generations and among people with a higher educational level, it cannot be precluded that the rejection rate might in future increase even further, rather than decrease.

Infants' best interests in end-of-life care for newborns.

Pediatric bioethics presumes that decisions should be taken in the child's best interest. If it's ambiguous whether a decision is in the child's interest, we defer to parents. Should parents be permitted to consider their own interests in making decisions for their child? In the Netherlands, where neonatal euthanasia is legal, such questions sometimes arise in deciding whether to hasten the death of a critically ill, suffering child. We describe the recommendations of a national Dutch committee. Our objectives were to analyze the role of competing child and family interests and to provide guidance on end-of-life decisions for doctors caring for severely ill newborns. We undertook literature review, 7 consensus meetings in a multidisciplinary expert commission, and invited comments on draft report by specialists' associations. Initial treatment is mandatory for most ill newborns, to clarify the prognosis. Continuation of treatment is conditional on further diagnostic and prognostic data. Muscle relaxants can sometimes be continued after withdrawal of artificial respiration without aiming to shorten the child's life. When gasping causes suffering, or protracted dying is unbearable for the parents, muscle relaxants may be used to end a newborn's life. Whenever muscle relaxants are used, cases should be reported to the national review committee. New national recommendations in the Netherlands for end-of-life decisions in newborns suggest that treatment should generally be seen as conditional. If treatment fails, it should be abandoned. In those cases, palliative care should be directed at both infant and parental suffering. Sometimes, this may permit interventions that hasten death.

Neonatal euthanasia: A claim for an immoral law

Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as clinicians into a law project, with the purpose of pinpointing several issues, specific of perinatality that should be addressed by such a law. In conclusion, we argue that the legalisation of neonatal euthanasia under exceptional circumstances is the only way to avoid all the “well-intentioned” malpractices associated with ending life at the very dawn of it.

The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt?

In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5...

Decisions About Periviable Babies in Dutch Neonatal Intensive Care Units; Quality-of-Life and Quality-of-Death Concerns

A substantial number of reports and studies in the last 10-15 years have described the physician’s attitude towards neonatal EoL decisions and medical practice in the Netherlands. Legal developments have supported the concept that the decision to withholding and withdrawing life-sustaining treatment in newborns can be regarded normal medical practice. Deliberate ending of life, however, is labeled as an extraordinary category of medical actions, both medically and legally, that requires reporting and review as described in the Groningen Protocol. A recent study has indicated that reports have become increasingly rare. This might be because deliberate life-ending has become virtually non-existent, or it might still occur unreported because it’s unclear to the physicians where the demarcation between ‘good’ palliative care and deliberate life-ending lies. The medical profession should and could work together to get this issue cleared up. Keywords: End-of-life decisions, neonatology, intensive care, ethics, comfort medications, neonatal euthanasia

Gas alternatives to carbon dioxide for euthanasia: A piglet perspective12

The search for alternative methods to euthanize piglets is critical to address public concern that current methods are not optimal. Scientific evidence supports that blunt force trauma is humane when performed correctly, but most people find it visually difficult to accept. The use of CO2 is often recommended; at the same time, it is criticized as being aversive to pigs. This research sought to 1) identify a method of scientifically determining if piglets find a gas aversive, using an approach-avoidance test, which relies on the perspective of the piglet, and 2) test different gas mixtures to determine if they are effective and humane for neonatal piglet euthanasia. Pigs were allowed to walk freely between 1 chamber filled with air and another chamber either gradually filled with gas mixtures (Exp. 1) or prefilled with gas mixtures (Exp. 2). Experiment 1 tested CO2 (90%) and air (10%), N2O (60%) and CO2 (30%), Ar (60%) and CO2 (30%), and N2 (60%) and CO2 (30%). Because piglets had to be removed when they started to flail, the test was shortest (P < 0.01) for the pigs in the CO2 treatment compared with pigs in the N2O/CO2, Ar/CO2, and N2/CO2 treatments, 3.1 ± 0.2, 8.5 ± 0.6, 9.6 ± 0.4, and 9.9 ± 0.1 min, respectively. Nonetheless, all gas mixtures adversely affected the pigs, causing the pigs to leave the test chamber. In Exp. 2, piglets were allowed to enter a chamber prefilled with N2/CO2 or N2O/CO2 (both 60/30%). Pigs exposed to the prefill chambers started to flail in fewer than 20 s, much faster in comparison with the gradual fill method, which supports that this method was more aversive. In Exp. 3, piglets were euthanized using a 2-step procedure. Pigs were first placed in a gradual fill chamber with 1 of 4 gas mixtures: 90% CO2, N2/CO2, N2O/CO2, or N2O/O2 (the last 3 mixtures at 60/30%) followed by placement into a 90% CO2 prefill chamber when the pigs started to flail or were anesthetized. All 3 gas treatments that contained CO2 killed pigs more quickly than N2O/O2 (P < 0.05). However, N2O/O2 was the only treatment that anesthetized the pigs instead of causing squeals or flailing although requiring about 12 min longer. Although longer, a 2-step procedure in which pigs are anesthetized with a mixture of N2O and O2 before being euthanized by immersion in CO2 may prove to be more humane than CO2 alone.

Prevention of fetal suffering during ovariohysterectomy of pregnant animals

JAVMA, Vol 240, No. 10, May 15, 2012 V who neuter cats and dogs sometimes find, for a variety of reasons, that they are required to spay pregnant animals. Ovariohysterectomy of pregnant animals in animal shelters and humane societies, for example, is commonly recommended to help reduce the overpopulation of unwanted dogs and cats and because shelters have a limited capacity to care for neonatal animals and neonatal animals often fare poorly in shelter environments. For feral cat control programs, ovariohysterectomy of pregnant females furthers the mission of population control and allows all animals brought to the clinic to be spayed the same day, eliminating the need for retrapping or extensive foster care. In the case of owned animals, owners may request pregnancy termination, and ovariohysterectomy is considered the best alternative for termination of unwanted pregnancies in cats and dogs not intended for breeding. Many veterinarians performing ovariohysterectomy in dogs and cats in the middle to later stages of pregnancy question the most appropriate way to ensure a humane death for in utero fetuses removed from the dam. Unfortunately, little guidance is available from published veterinary sources. For example, the 2007 AVMA guidelines on euthanasia, in the section on prenatal and neonatal euthanasia, simply state that “When ovarian hysterectomies are performed, euthanasia of feti should be accomplished as soon as possible after removal from the dam. Neonatal animals are relatively resistant to hypoxia.” However, the guidelines do not cite any research on whether chemical or physical means of euthanasia are recommended for in utero fetuses. In addition, the guidelines do not state the developmental stage at which fetuses might require euthanasia, nor do they recommend effective methods for euthanasia of fetuses or methods for determination of successful euthanasia. Similarly, no mention of fetal disposition is made in the Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs, nor is the topic discussed in other veterinary publications aimed at practitioners in the United States, including journals, textbooks, published guidelines, and trade magazines. The 2011 revision to the AVMA guidelines on euthanasia cites recent reviews indicating that euthanasia of fetuses is unnecessary, but this section is brief and may not provide sufficient information to assuage veterinarians’ concerns about fetal sensory awareness and suffering or provide veterinarians with an understanding of the various factors that influence fetal consciousness. Prevention of fetal suffering during ovariohysterectomy of pregnant animals

Éthique et médecine périnatale : deux étapes de la réflexion professionnelle française, 2001-2008

Constant advances in perinatal medicine in industrialized countries have raised challenging ethical dilemmas. This review addresses the evolution over the years 2000 of the recommendations on ethical issues in the perinatal period by health professionals in France. The Committee on Ethics of the French National Federation of Neonatologists issued one first set of recommendations in 2001. Additional information provided by nation-wide epidemiological studies on the long term development of premature infants, and the recent evolution of French law prompted the french societies of Neonatology, of Perinatal Medicine, and the National board of Obstetricians and Gynaecologists to set new guidelines concerning the end of life in the neonatal period and euthanasia, neonatal palliative care, parental information, and issues related to the limits of viability, which are currently being published. These recent guidelines are characterized with attitudes favouring palliative care and discouraging active ending of life on neonates in situations with extremely poor neuro-cognitive prognosis. Around the limits of viability, a grey zone is defined over the 24-25 weeks gestational age period, during which various options are discussed, in compliance with the basic principle of the preservation of the individual rights of each infant.

Neonatal Euthanasia: Why Require Parental Consent?

The Dutch rules governing neonatal euthanasia, known as the Groningen Protocol, require parental consent for severely disabled infants with poor prognoses to have their lives terminated. This paper questions whether parental consent should be dispositive in such cases, and argues that the potential suffering of the neonate or pediatric patient should be the decisive factor under such unfortunate circumstances.

Neonatal Euthanasia Is Unsupportable: The Groningen Protocol Should Be Abandoned

The growing support for voluntary active euthanasia (VAE) is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child's life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported.

Should euthanasia be legal? An international survey of neonatal intensive care units staff

Objective: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. Design:...

Neonatal euthanasia: moral considerations and criminal liability

Despite tremendous advances in medical care for critically ill newborn infants, caregivers in neonatal intensive care units still struggle with how to approach those patients whose prognoses appear to be...

Infanticide of defective newborns: an old midwife's story.

The story of how a midwife many years ago dealt with defective newborns is used to illustrate complete control by a system external to the family. Similarities exist with current public policy concerning the interrelated issues of abortion, neonatal euthanasia, and infanticide in which the family system is often ignored. It is argued that the family's values, expectations, and desires are relevant to the establishment of public policy in this sensitive domain.

Irrational and Pregnant

Bioethics provides many instances. In Rights Talk and in her earlier Abortion and Divorce in Western Law, Glendon char s the way the American rights dialect has helped turn the conflict over abortion into a cankerous and uncompromisable bitterness in American politics. Less dramatically (as I once argued in an a ticle called "Rights Discourse and Neonatal Euthanasia"), the debate over the treatment of defective newborns has been distorted by the anxiety of all sides to frame their case in terms of rights. And the Cruzan case exemplifies the way an attempt to constitutionalize an issue can divert a use-