The Groningen Protocol

AMSTERDAM, Netherlands — A hospital in the Netherlands—the first nation to permit euthanasia—recently proposed guidelines for mercy killings of terminally ill newborns, and then made a startling revelation: It has already begun carrying out such procedures, which include administering a lethal dose of sedatives. —lead paragraph of a story by Toby Sterling for the Associated Press

It seems obvious that we need a clear boundary to confer personhood on a human being and grant it a right to life. … Anti-abortionists draw the line at conception… Those in favor of abortion draw the line at viability… To a biologist, birth is as arbitrary a milestone as any other.

No, the right to life must come, the moral philosophers say, from morally significant traits that we humans happen to possess. One such trait is having a unique sequence of experiences that defines us as individuals and connects us to other people. Other traits include an ability to reflect upon ourselves as a continuous locus of consciousness, to form and savor plans for the future, to dread death and to express the choice not to die. And there’s the rub: our immature [newborns and infants] don’t possess these traits any more than mice do. —Steven Pinker, Harvard professor of psychology, in a NY Times Magazine article entitled Why They Kill Their Newborns, Nov. 2, 1997

I think we need to assume that most doctors (and nurses) want to relieve suffering and pain, and that they often find themselves overwhelmed by the human tragedies they face every day, tragedies that rarely touch the rest of us in any personal way.

But the Groningen Protocol, which allows a committee of doctors to decide that a newborn or infant is in pain and should actively be put to death, topples a barrier that has stood intact even in the permissive Netherlands: To be euthanized, a person must first give his informed and uncoerced consent. Though used so far to terminate the lives of infants, I predict that the Groningen Protocol will be expanded to others who are similarly incapacitated—the incurably mentally ill, those who are comatose and unresponsive, and those too frail to make decisions for themselves.

To kill an infant against its wishes would seem like murder. The courts have talked about a bright line that exists at birth: a baby can claim the rights of personhood once she has exited the birth canal. (This line of thinking explains why a full-term, viable fetus may be legally aborted through the procedure known as partial-birth abortion—the baby is deliberately held back from being delivered while the doctor ends its life.)

But some very bright people—Steven Pinker at Harvard, Princeton ethicist Peter Singer, and others—have long argued that personhood is not determined by location, but by qualities and abilities of the mind. By their reckoning, infants and young children are not true persons. Singer has said that infanticide is not immoral, because it is not the same as taking the life of a fully-developed person.

A survey by Don Marquis in the Journal of Philosophy showed that all pro-choice theories developed by 1989 deny that there is anything wrong prima facie with killing infants. I know of no pro-abortion scholar who has written that there is something intrinsically wrong with early postnatal infanticide. The reason is obvious: if the newborn has intrinsic (real, in our terms) dignity, then the same child located in the womb just prior to birth must have equal dignity. —Richard Stith, Professor of Law at Valparaiso University, in Nominal Babies, a survey of abortion-rights law for First Things, February 1999.

As a Christian, I am opposed to euthanasia because it places our human willfulness above the just and good purposes of God. But that is neither a legal nor a moral argument.

I also oppose euthanasia because it has sprouted from the cold and self-serving philosophy of utilitarianism, the doctrine that what is best for any individual is the ruthless pursuit of self-interest. In such a view, we are not intrinsically valuable as living beings created by God, nor are we all equally valuable to society, nor are all of us even persons. Our personhood, our value and our right to live depend on a complex calculus, a calculus which suggests that some of us are such a drag on society as a whole that we would be better off dead.

This sort of moral philosophy gives the group permission to sacrifice particular individuals for the greater good, which is precisely what the Groningen Protocol is doing in the Netherlands.

Luke! Trust your feelings! As we know, Luke does what he is told, and the galaxy is saved. How fortunate that he did not trust his mind and skill, as he was tempted to, because then the evil empire would have won. The Star Wars movies express a view of how to live, a morality of feeling, found far beyond the perimeter of the Dreamworks studio. As Keats wrote to a friend, ‘O for a life of sensations rather than of thoughts!’

While the morality of pleasant feelings ends with the likes of Peter Singer, who thinks little humans may be killed because their pleasures aren’t big enough, the morality of higher feelings ends with the likes of Hannibal Lecter, who thinks vulgar humans may be killed because their pleasures aren’t refined enough. It is all part of the same revolution. —J. Budziszewski, Associate Professor in the Departments of Government and Philosophy at the University of Texas at Austin in Feeling Moral, First Things, November 2002

The embryonic stem cell debate is about utilitarianism: putting human embryos to good use, to serve the greater good. Such arguments have also led to the use of aborted fetuses for research, and some suggest that cloning will create opportunities for human farming, where babies will be created and nurtured so that their organs can be harvested. Would society actually go that far?

I’m not willing to bet money against it. The Groningen Protocol proves that we are way beyond any slippery slope arguments. Abortion and euthanasia have put us on a high-speed, downhill toboggan run—the peak is no longer visible behind us, and the bottom is still a long, long slide down the mountain.

You can find more on the Groningen Protocol by reading Doug LeBlanc’s post, Managed Death Care at Get Religion. Also, Mark D Roberts has a fine series on the subject, beginning with Euthanasia in the Netherlands.

Finally, let me point you to an essay of my own on the wrenching experience of Dawn and Matt Smith and their Siamese twins, Brynleigh and Victoria, When Dreams Become Dust. The story of Brynleigh and Victoria is too sad for words, but I have nothing but admiration for the love and compassion shown these infants by their parents and the hospital staff during their too-short lives. Brynleigh and Victoria are precisely the sort of children who would be euthanized under the Groningen Protocol.

Should Brynleigh and Victoria have been euthanized at birth?

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  1. Thanks for this – very thought provoking.

  2. Don’t overlook the voice of the parents in this! As you state it all circumsized persons can now sue their parents since their was made a decision without their consent.

  3. The Netherlands (and especially the northern part where Groningen is) is one Europe’s most secular nations, therefore it is not that bizarre that the euthanasia law got passed in parliament just a couple of years ago. The so-called Groningen Protocol is a guideline for doctors at the academic hospital in Groningen to help them understand what procedures to take when performing euthanasia on infants. Please bear in mind that this protocol does not advocate nor condemns euthanasia, it merely provides the dotor performing the procedure, some help to make sure he is doing everything possible to be legally okay. Consent from parents, second and even third opinions are invaluable in proceding with the procedure.

    I can understand your comment(s) on euthanasia as a controversial subject, however the protocol is not an extension of the law (as some US media try to portray it as such) nor some kind of sick national act to kill unwanted babies. It’s just a guideline for the doctors as a ‘practical’ guide derived from the law. Compare it to a guidebook on how to fill in tax forms for example: so much paperwork involved so one could get a little help in interpreting the law.

    Neil – Amsterdam, Netherlands

  4. Thank you for the helpful clarification. I do understand that because euthanasia is permitted by law, doctors need guidance as to the appropriate circumstances to euthanize their patients, and the steps that must be taken before taking this very serious step.

    You are right that there has been mis-information printed in some US accounts. Speaking for myself, my primary concern is that it does seem that the Groningen protocol creates a precedent (that may be copied elsewhere) extending the right to euthanasia to a class of people who cannot express their own wishes, and whose wishes can only be guessed at.

    I hope I am wrong, but I believe this will inevitably extend the use of euthanasia to a whole new class of patients, those who are unable to express themselves, and that troubles me.

  5. The baby’s on for wich the Groningen Protocol applys are very sick. And will therefor, die. No matter what the doctors will or will not do. So allowing those baby’s to live would be allowing them to die very slow and painfull. You need to understand that all the infants are in pain and as said before, will die. The Groningen Protocol makes sure their death won’t be painful, but makes sure it’s painless. Unlike the natural death the baby’s whould have died.

  6. But there are some grey areas in the protocol:

    “…..Although it is difficult to define in the abstract, this group includes patients who are not dependent on intensive medical treatment but for whom a very poor quality of life, associated with sustained suffering, is predicted. For example, a child with the most serious form of spina bifida will have an extremely poor quality of life, even after many operations. This group also includes infants who have survived thanks to intensive care but for whom it becomes clear after intensive treatment has been completed that the quality of life will be very poor and for whom there is no hope of improvement.”

    See here for full text in NEJM

    what concerns me with this statement is the phrase “…quality of life will be very poor”. It concerns me for two main reasons:


    because it’s very difficult to determine the future health of a very severely physically-disabled person, not just because of technology, but also because individuals inherently don’t necessarily conform to the likely outcome of their illness (ie there is a small chance of remission or improvement)


    who defines what is considered to be a very poor quality of life? Like the author of the article above, I’m concerned that it will lead to very different criteria being applied in the future. An example of such a different outcome can be seen in the way the abortion law today is applied compared to its original intention.

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