For people outside the Netherlands, the most surprising thing about legally tolerated non-voluntary euthanasia of infants is that it happens at all. But for Dutch doctors, the surprise is that reports of it are far lower than the quota.

In 2007, under the so-called Groningen Protocol, a national review committee was instituted to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has surfaced. An article in the latest issue of the Journal of Medical Ethics speculates about why so few deaths have occurred.

There appear to be several reasons. First of all, the authorities may have over-estimated the number of infant deaths based on deficient data from previous years. Some abortions had also been wrongly reported as infant euthanasia. Improved ultrasound technology now allows doctors to abort defective babies before birth, making euthanasia unnecessary. There has been an increase in the use of “terminal sedation”, which is not regarded as euthanasia, even if it causes the death of the patient

But, still,  only one reported death? “It is likely that at least some cases of active ending of life occurred during the past years,” the authors admit. So why have the doctors kept it quiet?

One reason is that the committee to which the doctors are supposed to report the deaths has no legal authority and cannot shield them from a public prosecutor who is skeptical of their good intentions. This “may not inspire physicians with sufficient confidence to report their act”. Second, if an infant is suffering badly, the doctors prefer to call active euthanasia “adequate terminal care” because it makes the parents feel better. Third, if the infant is not suffering at the moment, but might in the future (as in spinal bifida cases), they would be in breach of the protocols. Anticipated suffering is not a reason for euthanasia – at the moment – in the Netherlands.

The upshot of all this, the authors conclude, is that “it seems virtually impossible to comply with the requirements in the current regulation”. So, they conclude, if the government really wants Dutch doctors to take seriously their duty of reporting cases of infant euthanasia, they need to make the protocols even more permissive. ~ Journal of Medical Ethics, April