Abstract
The Groningen Protocol, introduced in the Netherlands in 2005 and accompanied by revised guidelines published in a report commissioned by the Royal Dutch Medical Association in 2014, specifies conditions under which the lives of severely ill newborns may be deliberately ended. Its publication came four years after the Netherlands became the first nation to legalize the voluntary active euthanasia of adults, and the Netherlands remains the only country to offer a pathway to protecting physicians who might engage in deliberately ending the life of a newborn (DELN). In this paper, I offer two lines of argument. The first is a positive argument for the Protocol, grounded in the good of the newborn as unanimously determined by those in a position to determine it. The second addresses the widely shared belief that the killing of newborns is morally prohibited, where I offer two arguments—one grounded in the fact that the kinds of cases the Protocol is meant to govern are very rare and highly unusual, and the other focused more broadly on the role of pre-theoretical beliefs in moral reasoning—meant to undermine the strong role that the critic of the Protocol affords this belief. I argue that, given this second line of argument, the beliefs underlying my positive argument for the Protocol are in fact more secure than the widely shared belief underlying the critic’s position.
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Notes
This former strategy is suggested by Vanden Eijnden and Martinovici, who argue that newborns who the GP seems designed to address neither suffer nor are in pain (Vanden Eijnden and Martinovici 2013). This is an empirical assertion which can be rebutted if there exists some (at least one) medical condition, suffered by some (at least one) newborn child, whose severity is such that it inflicts on the child an extreme level of pain (and so suffering in the sense that Verhagen and Sauer have in mind). Given that this is extremely plausible given our best understanding of pain, and is brought to life in the case of epidermolysis bullosa, I pass by this objection.
This deeper interpretation of the slippery slope argument is potentially vulnerable to a deeper kind of empirical response, showing that end-of-life medical practice in neonatology is not fundamentally different than in other countries, even in those where euthanasia of any form is illegal, and even though the GP is unique to the Netherlands. And, in fact, the empirical evidence supports this response (Moratti 2010).
It is worth noting that this first argument fits with, though does not rely on, a common account of personhood. By this line of argument, personhood is a moral status requiring certain relatively sophisticated facts, typically psychological, to obtain about a being (Tooley 1972, Warren 1973, Singer 1993, McMahan 2002). Someone endorsing this kind of account would understand my first argument here in the following terms: while we have strong beliefs about the many newborns that are likely to grow into full human persons, our beliefs are weaker about newborns who will never develop in this way.
References
American College of Pediatricians. 2014. Neonatal euthanasia: The Groningen Protocol. http://www.acpeds.org/the-college-speaks/position-statements/life-issues/neonatal-euthanasia-2. Accessed February 18, 2016.
Appel, J.M. 2009. Neonatal euthanasia: Why require parental consent? Journal of Bioethical Inquiry 6(4): 477–482.
Caplan, A., and C.B. Cohen. 1987. Imperiled newborns. Hastings Center Report 17(6): 5–32.
Cassell, E. 1982. The nature of suffering and the goals of medicine. New England Journal of Medicine 306(11): 639–645.
Chervenak, F.A., L.B. McCullough, and B. Arabin. 2006. Why the Groningen Protocol should be rejected. Hastings Center Report 36(5): 30–33.
Drake, S. 2005. Euthanasia is out of control in the Netherlands. Hastings Center Report 35(3): 23.
Duff, R.S., and A.G.M. Campbell. 1973. Moral and ethical dilemmas in the special-care nursery. The New England Journal of Medicine 289(17): 890–894.
Greene, J.D., and J. Haidt. 2002. How (and where) does moral judgment work? Trends in Cognitive Sciences 6(12): 517–523.
Greene, J.D., R.B. Sommerville, L.E. Nystrom, J.M. Darley, and J.D. Cohen. 2001. An fMRI investigation of emotional engagement in moral judgment. Science 293(5537): 2105–2108.
Jotkowitz, A.B., and S. Glick. 2006. The Groningen protocol: Another perspective. Journal of Medical Ethics 32(3): 157–158.
Jotkowitz, A.B., S. Glick, and B. Gesundheit. 2008. A case against justified non-voluntary active euthanasia (the Groningen Protocol). The American Journal of Bioethics 8(11): 23–26.
Kodish, E. 2008. Paediatric ethics: A repudiation of the Groningen protocol. The Lancet 371(9616): 892–893.
Kon, A. 2007. Neonatal euthanasia is unsupportable: The Groningen protocol should be abandoned. Theoretical Medicine and Bioethics 28(5): 453–463.
Lindemann, H., and M. Verkerk. 2008. Ending the life of a newborn: The Groningen Protocol. Hastings Center Report 38(1): 42–51.
McMahan, J. 2002. The ethics of killing: Problems at the margins of life. Oxford: Oxford University Press.
Moratti, S. 2010. End-of-life decisions in Dutch neonatology. Medical Law Review 18(4): 471–496.
Nichols, S. 2004. Folk concepts and intuitions: From philosophy to cognitive science. Trends in Cognitive Science 8(11): 514–518.
Nuffield Council on Bioethics. 2014. Deliberately ending life. http://nuffieldbioethics.org/report/neonatal-medicine-2/deliberately-life/. Accessed February 7, 2016.
Paris, J.J. 2011. Standards, norms, and guidelines for permissible withdrawal of life support from seriously compromised newborns. The American Journal of Bioethics 11(2): 33–34.
Seymour, J. 2005. Parental rights and the protection of children; A presumption against state intervention? Australasian Journal of Professional and Applied Ethics 7(2): 16–30.
Singer, P. 1993. Practical ethics, 2nd ed. Cambridge: Cambridge University Press.
———. 2005. Ethics and intuitions. The Journal of Ethics 9(3): 331–352.
Ten Cate, K., S. Van de Vathorst, B.D. Onwuteaka-Philipsen, and A. Van der Heide. 2015. End-of-life decisions for children under 1 year of age in the Netherlands: Decreased frequency of administration of drugs to deliberately hasten death. Journal of Medical Ethics 41(10): 795–798.
Tooley, M. 1972. Abortion and infanticide. Philosophy and Public Affairs 2(1): 37–65.
Vanden Eijnden, S., and D. Martinovici. 2013. Neonatal euthanasia: A claim for an immoral law. Clinical Ethics 8(2-3): 75–84.
Verhagen, E. 2013. The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt? Journal of Medical Ethics 39(5): 293–295.
Verhagen, E., and P.J.J. Sauer. 2005a. End-of-life decisions in newborns: An approach from the Netherlands. Pediatrics 116(3): 736–739.
———. 2005b. The Groningen protocol—Euthanasia in severely ill newborns. New England Journal of Medicine 352(10): 959–762.
Warren, M.A. 1973. On the moral and legal status of abortion. The Monist 57(1): 43–61.
Willems, D.L., E. Verhagen, and E. van Wijlick. on behalf of the Committee End-of-Life Decisions in Severely Ill Newborns of the Royal Dutch Medical Association. 2014. Infants’ best interests in end-of-life care for newborns. Journal of Pediatrics 134(4): e1163–e1168.
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Tedesco, M. Dutch Protocols for Deliberately Ending the Life of Newborns: A Defence. Bioethical Inquiry 14, 251–259 (2017). https://doi.org/10.1007/s11673-017-9772-2
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DOI: https://doi.org/10.1007/s11673-017-9772-2