Is Euthanasia Acceptable for Severely Ill Infants?

PRO (yes)

Peter Singer, MA, Ira W. DeCamp Professor of Bioethics at the Princeton University Center for Human Values, in a chapter entitled "Justifying Infanticide and Non-Voluntary Euthanasia; Life and Death Decisions for Disabled Infants," excerpted from his 1993 publication Practical Ethics, wrote:

"When the life of an infant will be so miserable as not to be worth living, from the internal perspective of the being who will lead that life, both the 'prior existence' and the 'total' version of utilitarianism entail that, if there are no 'extrinsic' reasons for keeping the infant alive - like the feelings of the parents — it is better that the child should be helped to die without further suffering…

When the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of happy life for the first infant is outweighed by the gain of a happier life for the second. Therefore, if killing the haemophiliac infant has no adverse effect on others, it would, according to the total view, be right to kill him…

It may still be objected that to replace either a fetus or a newborn infant is wrong because it suggests to disabled people living today that their lives are less worth living than the lives of people who are not disabled. Yet it is surely flying in the face of reality to deny that, on average, this is so.

In any case, the position taken here does not imply that it would be better that no people born with severe disabilities should survive; it implies only that the parents of such infants should be able to make this decision. Nor does this imply lack of respect or equal consideration for people with disabilities who are now living their own lives in accordance with their own wishes…[The] principle of equal consideration of interests rejects any discounting of the interests of people on grounds of disability…

So the issue of ending life for disabled newborn infants is not without complications... Nevertheless the main point is clear: killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all."

1993 - Peter Singer, MA 

Eduard Verhagen, MD, JD, Director of Paediatrics at the University of Groningen, in a Dec. 10, 2004 University Medical Center Groningen press release titled "Paediatricians Call for Nationwide Protocol for the Ending of Life of Unbearably and Incureably Suffering Newborns," argued:

"It's time to be honest about the unbearable suffering endured by newborns with no hope of a future. All over the world doctors end lives discretely out of compassion, without any kind of regulation. Worldwide, the US included, many deaths among newborns are based on end of life decisions, after physicians reached the conclusion that there was no quality of life. This is happening more and more frequently...

A lot of disquiet has arisen around this issue, especially when the Vatican expressed concern. But these children face a life of agonizing pain. For example, we’re talking about newborns with hydrocephalus and no brain. Another example may be a child with spina bifida with a sack of brain fluid attached where all the nerves are floating around. This child is barely able to breathe, and would have to undergo at least sixty operations in the course of a year to temporarily alleviate its problems. These operations would not ease the pain. Moreover, the child would suffer such unbearable pain that it has to be constantly anaesthetised. The parents watch this in tears and beg the doctor to bring an end to such suffering.'...

This is a subject that nobody likes to acknowledge, let alone discuss. But it is in the interest of newborns who have to endure unbearable suffering that we draw up a nationwide protocol that allows each paediatrician to treat this delicate question with due care, knowing that he followed the criteria."

Dec. 10, 2004 - Eduard Verhagen, JD, MD 

Jasper Emmering, MD, Research Physician, in a Dec. 7, 2004 entry titled "In Defense of the Groningen Protocol," posted to his blog site, Hollandaise; Home of Total Blogging, wrote:

"I have seen an anencephalic child be born at full term in the Netherlands because the mother had refused an abortion. And I've seen the child die half an hour later. You see, in a liberal society, a woman's right to choose works both ways.

The reverse of mercy killing is not life, but a life of suffering...Killing is wrong, but so is torture. An adult patient who is compos mentis [of sound mind] who requests euthanasia considers life (such as he can live it) to be a fate worse than death...

There are always a few very unlucky innocent children who suffer from the most terrible afflictions. They usually die at an early age, after a few years of intense suffering. As with all children, their parents are entitled to withhold any treatment from their children, even life-saving treatment. After all, the parents are the child's legal guardians, and children's lives are routinely put in jeopardy by religious parents who refuse them vaccinations or blood transfusions. However, in these cases, even though withholding treatment would lead to a quicker death, it would also increase the suffering of the child. Actively ending the child's life would be painless. The temptation for mercy killing is there and has always been there. It is a fact of life. Like with euthanasia, mercy killing of suffering infants will not go away when you prohibit it. You can even ask yourself if there will be more mercy killings when you legalize it. Considering the rarity of these illnesses, the strictness of the [Groningen] protocol, and the commonness and strength of parental love, I really doubt that.

Better to have it out in the open where people like yourself can scrutinize the process, then to have parents, doctors and nurses risk years in prison for committing something they and many others see as a selfless act of mercy."

Dec. 7, 2004 - Jasper Emmering, MD 

Bertha Alvarez Manninen, PhD, Assistant Professor at Arizona State University, in the Nov. 2006 article, "A Case for Justified Non-Voluntary Active Euthanasia: Exploring the Ethics of the Groningen Protocol," published in the Journal of Medical Ethics, argued:

"These infants are terminally ill; modern medicine can do nothing to save them… Continued existence is of no benefit to them; rather, death is often looked upon as a much prayed for blessing. In these tragic cases, death is what constitutes the best interests of the infant and it is on the basis of this realisation that we recognise that passive euthanasia is what the primary moral principle of medicine - to do no harm - calls for.

Needlessly prolonging the lives of these infants counts against their interests, and so we concede to their deaths and allow them to occur…In these cases, the duty to do no harm may entail the positive duty of hastening death."

Nov. 2006 - Bertha Alvarez Manninen, PhD 

CON (no)

Marca Bristo, Chairperson of the National Council on Disability, in an Apr. 17, 1999 address to the Princeton community regarding the university's hiring of Peter Singer to the University Center for Human Values, said:

"I am not a philosopher or an ethicist, but I know what is right and what is wrong. Condoning the murder of infants is wrong. Devaluing the life of a human because of her disability is discriminatory, hateful, and bigoted. Peter Singer can package his ideas as utilitarian, practical, ethical, logical, even reasonable if he chooses. The plain truth is that Peter Singer thinks people with disabilities have lives that aren't worth living...

Singer argues that disabled infants may be killed ethically because they are not sentient beings. Sentient or not, babies with disabilities grow up to be children and then adults with disabilities. As an adult, this same person will likely have a much different view of his quality of life than his parent might have had based on the doctor's predictions at the time of birth. Studies have shown that people with disabilities usually have a much higher perception of the quality of their lives than people without disabilities have for them…

Singer's core vision, that the life of a person with a disability is worth less than the life of a person without a disability, and therefore it is okay to kill infants with disabilities if that is what the parent wants to do, amounts to a defense of genocide. It is sad that just as Dr. Kevorkian has finally been recognized in a court of law as being a criminal for acting on the basis of similar beliefs in the case of physician assisted suicide, Princeton sees fit to hire a proponent of infanticide to teach ethics to undergraduates.

Parents of a newborn with a disability are often in a state of shock and adjustment for a long period after the baby is born. Once this phase is over, most parents come to value their child with a disability and to learn about the benefits the entire family can realize from the perspective this child brings them. Singer would like to give parents an easy out so they can go ahead and have another child to 'replace' the defective baby. What parents in that situation need is information and support so that they can give that child the best possible chance to develop into an independent adult. They don't need a nudge from their doctor or their insurance company to put the baby out of its misery (and save the insurance company a few hundred thousand dollars as part of the bargain)."

Apr. 17, 1999 - Marca Bristo 

Alan B. Jotkowitz, MD, Professor of Medicine at Ben-Gurion University of the Negev and Shimon Glick, MD, Professor of Medicine at Ben-Gurion University of the Negev, wrote in a 2005 article titled "The Groningen Protocol: Another Perspective," published in the Journal of Medical Ethics:

"We agree that in certain situations it is reasonable and desirable to limit the level of care in these severely disabled and suffering infants: but the direct taking of human life crosses a major boundary line. Almost all civilised societies distinguish between an active act of taking another life and merely standing by and watching someone die. This distinction is recognised by most religions but is particularly felt by physicians and nurses, who have to perform the act, and who for centuries resisted the deliberate taking of human life...

Alternatives to euthanasia in the care of these infants certainly exist. Paediatric palliative care emphasises an interdisciplinary team approach to the physical, social, and psychological needs of the patient and their families, with expert management of pain and associated symptoms. This holistic philosophy of pain control, symptom management, and psychosocial support should be the standard of care for children with life threatening illnesses and resources should be provided for its implementation.

The sole criterion for ending the life of these infants is their poor quality of life. Who gave physicians the right to determine quality of life and to practise euthanasia on that basis? Infants need to be protected by society irrespective of their medical condition and not condemned to die. In many countries physicians have already abandoned the longstanding honourable medical tradition of not deliberately terminating human life, by accepting a policy of active euthanasia in terminally ill competent adults; there is no justification for extending that policy to suffering children."

2005 - Shimon Glick, MD 
Alan B. Jotkowitz, MD 

Bob Barr, MA, President and CEO of Liberty Strategies, LLC., and former US House Representative (R-GA), in a Dec. 26, 2004 Op-Ed column titled "Euthanasia ... or a 'Dutch treat,'" published in the Washington Times, wrote:

"Regardless of how one feels about euthanasia of the willing, I would hope most people agree ending someone's life without consent puts us at the top of a deeply disturbing, indeed frightening, slippery slope...

Groningen's guidelines...involve the actual medical homicide of individuals who can't protest or defend themselves. I have no doubt that if the Groningen Protocol becomes official, parents who don't want to contend with raising a disabled child will have their baby or young child euthanized, even if the baby has a fighting chance at a meaningful life. Likewise, family members who fear the burden of coping with a disabled or comatose loved one will seek his or her involuntary euthanasia out of their own self-interest.

Medical ethics has to be one of the most maddeningly complex fields of endeavor on the planet. The mental agility needed to contend with some of these issues is considerable. There is, however, one basic starting point for any ethical inquiry in medicine; one which, though not actually in the Hippocratic Oath, encapsulates its message. It is: 'above all, do no harm.' In other words, life of any quality is sacred in itself, and throughout the morass of ethical issues that arise in the practice of medicine and healing, the alpha and omega of everything should be the preserving of life.

The idea of involuntary euthanasia stands foursquare against that presumption in favor of human life."

Dec. 26, 2004 - Bob Barr 

Daniel A. Beals, MD, Associate Professor of Surgery at the University of Kentucky, wrote in a Mar. 24, 2005 posting titled "The Groningen Protocol: Making Infanticide Legal Does Not Make it Moral," published on the website of the Center for Bioethics and Human Diginity:

"In healthcare, we must safeguard the rights of the disabled. This is even more important when dealing with children: they cannot speak for themselves and parents are in a particularly vulnerable position. These children should be treated with special concern, to find every way to help them have fulfilling lives, not with distain, dismissing their lives as not worth living. I certainly can see how the authors would like to correct 'misunderstandings' about their protocol. One thing is not misunderstood: this is a blood-chilling crime against a helpless population. No amount of legal correctness will ever make this a moral decision. The fact that most of these cases of infant euthanasia are not reported only confirms that the practitioners themselves know this is wrong and should be concealed."

Mar. 24, 2005 - Daniel A. Beals, MD