By Hilary White

July 17, 2008 ( – A professional journal for pediatric nurses has produced an article examining the ethics of infanticide according to the Dutch Groningen Protocol. The Protocol permits the killing of babies in the Netherlands on the judgement of a physician based on “quality of life” criteria. The article, appearing in the May-June 2008 edition of the Journal of Pediatric Nursing, and jointly authored by J. Catlin and Renee Novakovich, talks about the effects of the Protocol on medical ethics in the US.

The piece, “The Groningen Protocol: What Is It, How Do the Dutch Use It, and Do We Use It Here?” calls the issue “complex.” The authors describe work undertaken by the American Nurses’ Association (ANA) to help nurses define “the differences between euthanasia, assistance in dying and palliative care.” The authors also write that although there are wide divisions in opinion on the direct killing of disabled infants, countries must continue to examine the moral, medical, ethical and legal aspects.

However, bioethics writer and critic Wesley J. Smith is sounding a warning, saying that as soon as academics start approaching an issue of life and death with terms like “complex” and “gray areas” and “difficult,” the ground is already laid for acceptance.

Wesley J. Smith commended the article’s dispassionate approach to the issue, but said that this is really the crux of the problem, for, “The authors’ rigorous objectivity about a matter that should be ipso facto condemned, is, to me, very worrying.”

“Beware! What we don’t condemn, what we claim to be mere ‘dilemmas,’ we eventually are urged to allow. Infanticide is moving into the mainstream of bioethics and the medical intelligentsia.”

The article also contained a few linguistic cracks in its shell of “objectivity.” In particular it hinted that American hospitals, which spend millions caring for premature infants, do so at the expense of “social justice,” the principle of “non-malficence” or “allowing no harm.”

On the other hand, the article implies, countries with government-supported medical systems, such as Canada, Britain and the Netherlands, will be more likely to weigh the scales in favour of infanticide as a form of “social justice” in order to make more of the public medical system available for more worthy patients.

“In countries with socialized medicine, the principles of social justice and non-maleficence (avoiding doing ‘good’ which causes suffering) have been seen as more important,” they say.
  The Groningen Protocol was developed by Dutch paediatrician Eduard Verhagen and a group of doctors at the Groningen University Medical Centre in 2004. It allows doctors to make a judgement on the level of suffering of an infant and whether it should be killed by lethal injection. Verhagen summed up the Bioethics principle of “beneficence,” saying in an interview, “Death can be more humane than continued life if (life) involves extreme suffering.”

Smith has argued that the purpose of the Groningen Protocol is not so much to help legalise infanticide of disabled babies in the Netherlands, but to create a template by which legalised infanticide may spread outward to the rest of the world.

In the Netherlands the Groningen Protocol was not the first indicator that Dutch doctors had been killing disabled babies. In 1992, the Dutch Royal Society of Medicine published guidelines to be used in deciding whether to kill a baby. One of the criteria was to consider whether the child would ever be able to live independently, experience “self realization” (being able to hear, read, write, labor) and have meaningful interpersonal relations. By 1993 it was revealed that three out of eight neonatal intensive care units in the Netherlands had specific policies allowing infanticide by lethal injection and this was endorsed by the Dutch Pediatric Society.

Read related coverage:

Editorial: Infanticide Goes Mainstream and Why Prolife Arguments Need an Update

SHOCK: Newborns Who Suffer are “Better off Dead” – “World’s Most Prestigious” Bioethics Journal

Dutch Euthanasia Doctor Admits to Killing 4 Newborns With Lethal Injections