In the Netherlands, the Groningen Protocol – a kind of agreement between the order of doctors and the Dutch public prosecutor's office – already guarantees the absence of prosecution if a doctor puts an end to the life of a newborn child under the age of 1 year, subject to certain conditions. Euthanasia is already in place for adults and children over 12 years old.
A section of the medical world is calling for the application of this regime for children under 12 years old. The Ministry of Justice proposed in September to be part of the exception to the criminal code of “force majeure as an emergency situation,” article 40 of the Dutch Criminal Code.
The project was submitted to parliamentarians by the Minister of Justice, and was the subject of discussion in the hemicycle. It provides that a doctor can end the life of a child between the ages of 1 and 12 under certain conditions:
- The suffering is hopeless and unbearable and cannot be relieved in any way, even by palliative care.
- The doctor discussed the diagnosis and prognosis with the child, according to his ability, and explained to him that ending his life was the only way to end his suffering; the child gives no sign of opposition.
- The parents are informed and have given their consent for this euthanasia.
- The doctor has consulted at least one other independent doctor, whose opinion is however not
- The death procedure on the child is carried out “with due care.”
Negative Opinion of the College of Prosecutors General
The ministry asked for an opinion from the College of Public Prosecutors, which expressed a negative opinion. The College considers that putting an end to the lives of people who do not have the capacity for discernment, such as certain children under 12, constitutes too important a matter to be framed by a simple ministerial regulation, which is not a law.
The College underlines the lack of clarity, in particular concerning the difference between the “normal” medical act around the end of life, and the fact of actively ending the life of the child. The College wonders: does the term suffering cover an insufficient quality of life? To what extent should the suffering of parents be taken into account?
The Federation of Dutch Doctors (KNMG) has also issued a negative opinion on the project. It is particularly concerned about the repercussions that could ensue for other groups of patients lacking capacity for discernment.
What Cases Are They Talking About?
Interviews carried out with the parents of seriously ill children, and who would have liked their child's life to be shortened, reveal that the latter mainly suffered from cancer, neurological, or metabolic diseases, or that effecting the heart or muscles, uncontrollable epileptic seizures, and finally the ineffectiveness of certain sedations at the end of life.
These “extreme cases” raise from the outset the issue of pediatric palliative care, not only in terms of pain management, but perhaps especially in terms of the meaning of the days remaining. They stress the urgent need for medical and societal progress in this area, which would risk being short-circuited in many ways by the approval of a death procedure for these children.
The measure was announced on April 14 by the Minister of Health, Ernst Kuipers. Euthanasia will be applied to children between the ages of 1 and 12 whose death is inevitable and who suffer unbearable pain. According to the Minister, this should concern between five to ten minors per year.
As envisioned, the measure will be implemented through a settlement that will focus on a “small group” of children with “an illness or disorder so severe that death is unavoidable” and which should be implemented in the near future.
Mark Rutte’s government plans to publish the regulations this year and to carry out an evaluation some time after they come into force.
The Minister of Health’s claims should not be taken at face value: the laws on euthanasia, in all the countries where they have been implemented, follow the salami law [using repetitive, limited faits accomplis to expand a law, ed.]. It is promised that the law will be perfectly framed, and will only be applied in such and such a case… And a few years later a first extension will appear concerning either the cases or the age. It's just a matter of time.