"After-birth abortion" already exists in the Netherlands

Michael Cook
4 May 2013
Reproduced with Permission

"After-birth abortion: why should the baby live?" by Alberto Giubilini and Francesca Minerva, was merely an infanticide thought-experiment. The special issue of the Journal of Medical Ethics includes a contribution from a paediatrician who actually has done it. Dr Eduard Verhagen, a paediatrician at University Medical Centre Groningen in the Netherlands, says that, in his experience, infanticide is sometimes preferable to second-trimestre abortion.

The so-called Groningen Protocol (GP) in the Netherlands allows euthanasia of newborns under strict conditions if there is "hopeless and unbearable suffering" and both parents give "informed consent". Dr Verhagen claims that there were fewer instances of newborn euthanasia after the publication of the GP - but for reasons not connected with it. With more prenatal screening, more women opted for terminations of pregnancy in difficult cases like spinal bifida. The number of newborn euthanasia cases actually fell from 15 in 2005 to 2 in 2010.

The GP is, of course, very controversial. In an article in The Lancet in 2008, a paediatric oncologist and bioethicist at the Cleveland Clinic, Erik Kodish, angrily repudiated it. "The very notion that there is an 'accepted medical standard' for infanticide calls for resistance in the form of civil disobedience," he wrote.

However, in some cases, "after-birth abortion" might be the most sensible treatment, Verhagen believes, as it allows the parents and the doctors to make a more accurate diagnosis and to discuss treatment opinions. "If all stakeholders conclude that the prognosis is very grim, the babies condition is judged as one with sustained and intolerable suffering, and the parents request for euthanasia, why should that not be permissible as an alternative to second trimester termination?"

In any case, Dr Verhagen points out, the official opinion of the American Academy of Pediatrics is that it is morally permissible to withdraw or withhold hydration and nutrition from newborns in some cases. These include "children in a persistent vegetative state or children with anencephaly". This is a form of euthanasia, but the child lingers for a long time while it starves to death. "If the parents wish to shorten that course, and organise their child's death more in the way they have envisioned it, shouldn't euthanasia be available for them?"