"Pediatric" euthanasia?” “

Reports coming out of Holland on the euthanasia practised on newborn infants with grave pathologies are giving rise to debate. On this question, the Italian National Council for Bioethics signed a motion, in its plenary session on 28 January, to “re-affirm some fundamental bioethical principles”. HOLLAND: HOPE AND SUFFERING. 22 cases of active euthanasia practised on newborn infants with incurable diseases have been registered in the Netherlands between 1997 and 2004. These figures emerge from a study published by the specialized medical journal “Nederlands Tijdschrift voor Geneeskunde” (“Medical Journal of the Netherlands”) in late January, and are reported by the official journal of German physicians. According to the information provided by the Dutch study, the public prosecutor’s office has closed its own internal inquiries on all the documented cases although, according to Dutch law, active assistance in death for minors is a penal offence in the Netherlands. Nonetheless, the study reports that the doctors involved respected the necessary criteria to prevent the judiciary from taking any provisions; in all the cases considered the children were suffering from a grave form of spina bifida and hydrocephaly and assistance in death was motivated by the doctors by the claim that the disease was incurable and there was no chance of alleviating the sufferings. In all cases, moreover, there was a prior consultation with at least two physicians not belonging to the medical team directly involved and in 17 of the 22 cases an “interdisciplinary team for spina bifida” was even consulted. It also emerges from the study that the parents of the children gave their consent and in 4 cases expressly requested the doctors to put an end to their child’s life. According to the Dutch law on euthanasia, active assistance in death and medical complicity in suicide are not penal offences on certain conditions. First, the doctor must have come to the conviction that the patient has requested assistance to die “of his own free will and following careful reflection”. Second, it must be shown that the condition of the patient “is without hope and his/her suffering intolerable”. A fellow-doctor must be consulted and the responsible physician must attest he “carried out euthanasia with every possible medical care”. Hitherto active euthanasia, according to Dutch law, is only possible for persons over the age of 16, in exceptional cases from the age of twelve. Pediatricians of eight university clinics want to be released from the judicial doubts in the case of euthanasia practised on the newborn and in the so-called “Groningen Protocol” give advice on cases in which active euthanasia in the death of the newborn affected by incurable diseases should, in their view, be practised. These criteria, maintains the report, would correspond to some 600 annual cases worldwide and between 10 to 15 annual cases of newborn infants in Holland. According to the chairman of the Federal Council of German Physicians, Jörg-Dietrich Hoppe, the Dutch development is an example that confirms the slippery slope theory. In his view, the decisive element in the Dutch cases is not compassion, but far more material considerations. ITALY: REMOVING MISUNDERSTANDINGS. “The merciful suppression of newborn and children suffering from incurable diseases or suffering due to handicaps of the highest gravity”, a practice “it would not be incorrect to define as ‘paediatric euthanasia’”, “is sometimes misleadingly perceived as mere requests for the termination of therapeutic perseverance, giving rise to misunderstandings that need to be removed”: that is the firm stance taken by the Italian National Council for Bioethics in response to the reports coming out of Holland and other European nations. The interruption of therapeutic perseverance, where there is “no credible therapeutic prospect for the patient”, remains – says the Council – “not only licit but also ethically proper”. But it “must never be the occasion or pretext for therapeutic abandonment”. Every “intervention that has the character of deliberate euthanasia on minors” is, according to the Council, “neither bioethically or juridically” licit, since “newborn infants and children clearly cannot give any valid consent”. The Council expresses, in particular, firm condemnation of euthanasia practised “on children with congenital handicaps, even particularly severe ones, given that the compromise of so-called quality of life cannot justify its suppression in any case, neither ethically nor juridically”. We need to defend the life of the newborn and children, concludes the Italian Council for Bioethics, “against all abuses that threaten their right to life and health, even if the dramatic context of their disease often makes it difficult to perceive it”.