What Is the Groningen Protocol and Why Was It Drafted?

General Reference (not clearly pro or con)
Eduard Verhagen, MD, Neonatologist and Clinical Director of Pediatrics in the Department of Pediatrics at the University of Groningen, Netherlands, and Pieter J. J. Sauer, MD, Chairman and Professor in the Department of Pediatrics /Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands, in a Mar. 10, 2005 article titled "The Groningen Protocol - Euthanasia in Severely Ill Newborns," published in the the New England Journal of Medicine, offered the background of the Groningen Protocol:

"Newborns... however, cannot ask for euthanasia, and such a request by parents, acting as the representatives of their child, is invalid under Dutch law. Does this mean that euthanasia in a newborn is always prohibited? We are convinced that life-ending measures can be acceptable in these cases under very strict conditions: the parents must agree fully, on the basis of a thorough explanation of the condition and prognosis; a team of physicians, including at least one who is not directly involved in the care of the patient, must agree; and the condition and prognosis must be very well defined. After the decision has been made and the child has died, an outside legal body should determine whether the decision was justified and all necessary procedures have been followed...

[We] developed a protocol in 2002, in close collaboration with a district attorney. The protocol contains general guidelines and specific requirements related to the decision about euthanasia and its implementation. Five medical requirements must be fulfilled; other criteria are supportive, designed to clarify the decision and facilitate assessment. Following the protocol does not guarantee that the physician will not be prosecuted. Since implementing this protocol, our group has reported four cases in which we performed a deliberate life-ending procedure in a newborn. None have resulted in prosecution.

Dilemmas regarding end-of-life decisions for newborns with a very poor quality of life and presumably unbearable suffering and no hope of improvement are shared by physicians throughout the world. In the Netherlands, obligatory reporting with the aid of a protocol and subsequent assessment of euthanasia in newborns help us to clarify the decision-making process. This approach suits our legal and social culture, but it is unclear to what extent it would be transferable to other countries...

Requirements of the Gorningen Protocol that must be fulfilled:

  • The diagnosis and prognosis must be certain

  • Hopeless and unbearable suffering must be present

  • The diagnosis, prognosis, and unbearable suffering must be confirmed by at least one independent doctor

  • Both parents must give informed consent

  • The procedure must be performed in accordance with the accepted medical standard."

Mar. 10, 2005 - Pieter J.J. Sauer, MD, PhD 
Eduard Verhagen, JD, MD 

The University Medical Center Groningen, in a Dec. 10, 2004 press release titled "Paediatricians Call for Nationwide Protocol for the Ending of Life of Unbearably and Incureably Suffering Newborns," reported on the drafting of the Groningen Protocol:

"Paediatricians at academic hospitals in the Netherlands have called for the formation of a national committee to draw up a nationwide protocol for life ending treatment for newborns who are so ill and suffering so severely that they have no prospect of a future. The issue expressly relates to exceptional cases, around 600 newborns a year worldwide...

The call to set up a national committee has been prompted by the discussions that erupted worldwide after paediatricians from Groningen University Hospital announced that they had drawn up a protocol for such cases in association with the Dutch public prosecutors, called Board of Procurators General.

[Eduard] Verhagen: '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.'

Studies have shown that paediatricians worldwide are, in exceptional cases like this, in favour of deliberate ending of life. In France 74% believe that it should be acceptable in certain circumstances. The figure for the Netherlands is 72%."

Dec. 10, 2004 - University Medical Center Groningen (UMCG) 

Toby Sterling, reporter for the Associated Press, in a Dec. 1, 2004 article titled "Hospital Performs Euthanasia on Infants," published in the Washington Times, reported on the release of the Groningen Protocol guidelines:

"AMSTERDAM — A hospital in the Netherlands — the first nation to permit euthanasia — has proposed guidelines for mercy killings of terminally ill newborns...

The announcement by the Groningen Academic Hospital came amid a growing discussion in the Netherlands on whether to legalize euthanasia on people who are incapable of deciding for themselves.

In August, the main Dutch doctors' association KNMG urged the Health Ministry to create an independent board to review euthanasia cases for terminally ill people 'with no free will,' including children, the severely mentally retarded and people left in irreversible comas after accidents…

The Groningen Protocol, as the hospital's guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when the child's medical team and independent doctors agree that the pain cannot be eased and that there is no prospect for improvement and when parents think it's best.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions and diseases where a child could survive only on life support for the rest of its life, such as severe cases of spina bifida, a neural tube defect; and epidermosis bullosa, a rare blistering illness…

Groningen estimated that the protocol would be applicable in about 10 cases per year in the Netherlands, a country of 16 million people."

Dec. 1, 2006 - Toby Sterling