Pediatric Nurses Ponder Euthanasia

Editor’s Note—This article was actually written last year. We are publishing it now to show that certain topics currently featured in the public debate over “health care reform”—such as euthanasia, assisted suicide, and “death panels”—have been under discussion for quite some time among medical professionals and public officials. Such discussions naturally occur when a civilization abandons God as its source of all morality.

“More significant than the vote was the attitude of the nurses that euthanasia is an open question, one for man to decide or vote upon. Today they vote in favor of killing the aged and the infirm; will they vote to kill the doctors tomorrow? Or will the doctors vote to kill all nurses?”—R. J. Rushdoony, 1970^[i]

“[T]he authors’ rigorous objectivity about a matter that should be ipso facto condemned is, to me, very worrying…—Wesley J. Smith, 2008^[ii]

US Pediatric Nursing Journal Toys with Condoning Infanticide
Writes countries must continue to examine the moral, medical, ethical and legal aspects of direct killing of disabled infants—LifeSite News headline, July 17, 2008^[iii]

Is the Dutch penchant for euthanasia soon to be imported to America? Do pediatric nurses in this country think it’s time we started euthanizing newborn babies, under certain circumstances?

Pediatric Nursing raised these questions by publishing in its May-June 2008 issue an article by Anita Catlin, “The Groningen protocol: what is it, how do the Dutch use it, and do we use it here?”^[iv]

The Groningen protocol “allows decisions to be made by parents and their doctors to end the lives of severely ill newborns, defined as those ‘with no chance of recovery’ and/or who are deemed to ‘endure intolerable suffering before death,’” according to Catlin’s article.

Critics charge that even to consider the Groningen protocol is to put us on a slippery slope, morally. We answer that America is already parked on that slippery slope, and that the brakes are slipping. After all, R. J. Rushdoony discussed this issue 38 years ago, and many have discussed it since.

But first let’s examine the Groningen protocol itself, in an article written by the man who first conceived it.

The Groningen Protocol

Eduard Verhagen, M.D., is the medical director of the department of pediatrics at the University Medical Center Groningen, in the Netherlands. In 2005 he wrote an article for the New England Journal of Medicine entitled “The Groningen Protocol—Euthanasia in Severely Ill Newborns.”^[v]

Why did Verhagen deem it necessary to publish the article? He explained, “During the past few months, the international press has been full of blood-chilling accounts and misunderstandings concerning this protocol.” We shall return to the question of why such blood-chilling accounts might have arisen.

Under the protocol, Verhagen wrote, three classes of newborn babies would be candidates for euthanasia:

1. “[I]nfants with no chance of survival… who will die soon after birth, despite optimal care with the most current methods available locally. These infants have severe underlying disease, such as lung and kidney hypoplasia.” [That is, they have been born with abnormally small and inadequate lungs or kidneys.]
2. Infants with “a very poor prognosis… dependent on intensive care,” who “may survive… but expectations regarding their future condition are very grim,” such as “infants with severe brain abnormalities or extensive organ damage caused by extreme hypoxemia” [insufficient oxygen in the blood].
3. Infants “with a hopeless prognosis who experience what parents and medical experts deem to be unbearable suffering… not dependent on intensive medical treatment but for whom a very poor quality of life… is predicted.”

“Most such infants,” Verhagen wrote, “die immediately after such treatment has been discontinued… intensive care treatment is not a goal in itself. Its aim is not only survival of the infant, but also an acceptable quality of life.”

Upon the birth of such a baby, he wrote, parents and physicians will consult together. Then:

1. “[T]he parents must agree fully” that the child should be euthanized.
2. A team of physicians, “including at least one who is not directly involved in the care of the patient, must agree.”
3. “[T]he condition and prognosis must be very well defined.”
4. Finally, after the child has been killed, “an outside legal body should determine whether the decision was justified and all necessary procedures have been followed.”

The Horror Stories

It all sounds very reasonable and well-intentioned. The child is going to die, no matter what the doctors do; he’s suffering, and his parents are suffering; and everybody wants to do what’s right. So why the horror stories?

Maybe the “blood-chilling accounts” that concerned Dr. Verhagen had something to do with the Remmelink Report of 1991, an official Dutch government study of the practice of euthanasia in the Netherlands.^[vi]

The report found that in 1990, 1,040 people in Holland died from “involuntary euthanasia”—that is, their doctors simply took it upon themselves to kill them. Investigators found that “14% of these patients were fully competent,” “72% had never given any indication that they would want their lives terminated,” and “In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible.”

That’s not all. Investigators also reported that “8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the purpose of controlling pain, but to hasten the patient’s death.” Dutch doctors, according to the report, “deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections,” accounting for 9% of Holland’s overall death rate for that year.

In 45% of cases involving hospitalized patients who were involuntarily euthanized, “the patients’ families had no knowledge that their loved ones’ lives were deliberately terminated by doctors.”

Facts and figures like those featured in the Remmelink Report must have warned Verhagen that devising a protocol to euthanize newborns would come with its own built-in public relations problems.

Compelling Cases?

The Pediatric Nursing article recapitulates Verhagen’s writings for the New England Journal of Medicine, and also offers case studies that are meant to be compelling. One involves a baby boy in Holland whose skin kept sloughing off. Unable to relieve his condition, doctors killed him at the age of three months. The other involved a baby girl in the U.S. born with defective lungs, who “would never sustain life off a ventilator.” Although this child, at six months old, was reported “cognitively normal,” able to play, to love and be loved, she was taken off the ventilator, given pain killers, and allowed to die of her inability to breathe. “The nurses,” says the case study, “reported a great deal of moral distress.”

The article has been described as noteworthy for its “nonjudgmentalism,”^[vii] but we did not find it so.

The two case studies hardly cover all the ground laid out by Verhagen himself in deciding which newborns should become candidates for euthanasia. Anyone can find extreme cases to support virtually any position. But many of the babies euthanized in Holland, according to Verhagen’s NEJM article, were only born with spina bifida—an affliction, to be sure, but not an insurmountable obstacle to a meaningful life. The world is full of disabled persons who would very much object to their lives being taken from them.

We are leery of the Pediatric Nursing article’s use of euphemisms. For instance, “medications used to intentionally end the life of a neonate” might be more honestly called “poisons,” and “muscle relaxants… to minimize any signs or symptoms of struggle” are most certainly for the benefit of the beholder more than the “patient”—who might more candidly be called the “victim.” Doctors do as much for murderers condemned to die by lethal injection; and critics of capital punishment charge that the muscle relaxants don’t relieve the suffering, but only hide it from the witnesses.

At this point it becomes difficult to tell a euthanasia from an execution.

The Social Justice Argument

Most egregious, we found, was the article’s discussion of the issue in terms of costs. The actual language used is rather opaque, but we shall quote it here:

“In the U.S., with the desire for beneficence (doing good), the lives of extremely premature infants are frequently supported at the estimated cost of nearly one million dollars per hospitalization. The principles of social justice (care for all children) and non-maleficence (allowing no harm) are seen as less important. However, 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. As long as the U.S. health care system supports the use of extensive technology for infants with life-limiting conditions and provides reimbursement for extremely long hospital stays, the dilemma over what some might consider miracles and others view as suffering will continue” [emphasis added].

We don’t find this to be “rigorously objective” at all: in fact, it is Exhibit A for our contention that we are already on the slippery slope—especially in an election year when “free health care,” which means socialized medicine, is a recurring campaign issue.

We might even rephrase the quoted paragraph:

“With all the money and medical resources we waste on these hopeless cases, we could be treating thousands of more deserving patients whose prognosis is very much more hopeful. That many of those cases go untreated is the fault of America’s health care system for allowing parents to insist on treatment for babies who at best will grow up to be hopeless cripples.”

Strong language, perhaps: but if the system is to be changed to give the state the power to decide who gets what medical treatment, then medical decisions will inevitably become political decisions.

We’re Already There

“I do not think it is always wrong to kill an innocent human being. Simply killing an infant is never equivalent to killing a person.”—Peter Singer, 1999 ^[viii]

“Whenever the state or man goes beyond God’s law, it establishes man or the state as sovereign over life. The right to exist then becomes a grant from the state, which has then also the ‘right’ to kill man at will.

“[T]he state now, according to the courts, can define what constitutes a person. The definition of a person is no longer theological or even medical: it is civil and legal. We can be declared non-persons by the state or the courts and denied life.”—R. J. Rushdoony, 1984^[ix]

Peter Singer is an eminent bioethics professor at Princeton University. The fact that he holds that professorship is proof that someone, at least, is listening to him, and holds him and his opinions in high esteem. And his opinion is that an infant is not a person.

We are already on the slippery slope.

In the Netherlands, before the Groningen protocol was adopted, Dutch doctors were already euthanizing newborn babies on their own initiative. In his NEJM article, Verhagen said, “We believe that all cases must be reported if the country is to prevent uncontrolled and unjustified euthanasia.”

So the Groningen protocol was not devised to usher in the euthanasia of newborn babies, but to attempt to control and regulate something that was already being done. Furthermore, as reported in the Pediatric Nursing article, Dutch prosecutors and courts were not jailing physicians who purposely killed off their patients, newborn or otherwise.

Judging by the findings of the Remmelink Report, by 1990 euthanasia was already a routine procedure in Dutch hospitals.

But things are different in the U.S., says the Pediatric Nursing article: “The use of direct euthanasia in the U.S. for infants is not and will not be acceptable.”

Are They or Aren’t They?

But are American pediatric nurses toying with the idea of euthanasia for newborns? Are they considering the Groningen profile, or something similar? Is Anita Catlin’s conclusion of “is not and will not be acceptable” something we can bank on?

We contacted the National Association of Pediatric Nurse Practitioners (NAPNAP) to ask for a clear statement of their position. After several phone calls, this was the answer we got from the organization’s president, Linda Lindeke, Ph.D., R.N.:

“NAPNAP does not have a specific position on the Groningen protocol. We have NAPNAP members with expertise in pediatric palliative care. NAPNAP supports ongoing dialogue within the nursing profession and more broadly regarding end-of-life compassionate and ethical care that is family-centered and culturally appropriate.”

We interpret this to mean, at least as far as NAPNAP’s official position is concerned, that euthanasia is still an open question among nurses—just as it was in 1970, when Rushdoony wrote about it. In 38 years, the nursing profession has still not been able to bring itself to agree that “Thou shalt not kill.”

We are on the slippery slope. The arguments in favor of euthanasia have already been made, and the medical professionals have not rejected them. In Holland the actual procedures have been in place for years, but the medical professionals here in America have not troubled themselves to offer any ringing denunciations of it.

It might seem heartless to insist that extraordinary medical procedures, at great cost, be undertaken to keep alive, for as long as possible, a baby whose skin keeps falling off, and for whom the only prognosis is certain death, sooner or later, in spite of anything that might be done. But not undertaking these procedures in the first place is not quite the same as purposely killing the baby. And as we have seen from the Remmelink Report, once euthanasia is allowed at all, it has an irrepressible tendency to be expanded. From euthanasia for “hopeless cases,” we drift inexorably into euthanasia for babies born with Down’s syndrome, cleft palate, malformed limbs, or any other imperfection.

Is a clear statement for or against euthanasia too much to ask from our country’s doctors and nurses? The Pediatric Nursing article describes the issue as “complex,” or “confusing.” But how complex or confusing is God’s commandment not to kill?

“Beware!” said Wesley Smith. “What we don’t condemn, what we claim to be mere ‘dilemmas,’ we eventually are urged to follow. Infanticide is moving into the mainstream of bioethics and the medical intelligentsia.”^[x]

The confusion, of course, springs from our inability or our unwillingness to trust in God—especially in the presence of suffering. This is our flesh speaking.

Rushdoony put it very well:

“We trust in so many idiocies, including ourselves. Why not take God at His word and trust Him? If we do not believe that God is true to His word, how can we believe that God will be true to us who distrust Him? One of the church’s greatest sins is its refusal to trust in the Lord. How can God honor such a people?”^[xi]

How, indeed?