Dutch law leads to confusion over when to use life ending treatment in suffering newborns

The Dutch Medical Association is to scrutinise how doctors treat newborn babies with very serious abnormalities after it emerged that uncertainty exists among the profession over the criteria for mercy killing. Experts fear that any uncertainty could jeopardise standards of terminal care.

Since 2007 paediatricians may escape prosecution if they report “actively ending the life of a newborn” and meet certain criteria, including establishing that the baby is experiencing hopeless and unbearable suffering. But only one case has ever been reported (BMJ 2009;339:b4993, doi:10.1136/bmj.b4993), and research indicates that there should be 15 such cases a year.

Experts writing in the association’s journal, Medisch Contact, suggest that doctors are not failing to report but are rejecting treatment that would be considered “life ending” and that would therefore require the legal criteria to be met.

This is because doctors doubt whether the criterion of hopeless and unbearable suffering can be established in newborns. The Dutch laws on voluntary euthanasia apply to patients aged 12 years or older, and the experts say that whereas “young adults can conclude for themselves if their suffering is unbearable, a newborn cannot.”

They also argue that visible suffering, such as symptoms of pain and breathlessness, can be suppressed.

If this criterion for actively ending life cannot be fulfilled then doctors have no alternative but to remain passive by withdrawing artificial feeding and concentrating on the newborn’s comfort but not intervening as the medical condition deteriorates. This means that the newborn may not die immediately, and doctors fear that the “quality of the death” could suffer.

One of the authors, Gert van Dijk, an ethicist at the Erasmus University Medical Centre in Rotterdam, said, “These newborns will still die but it can take days or weeks. Parents and doctors believe this is wrong, but doctors don’t dare to act for fear of prosecution. It is an undesirable effect of the law.”

The Dutch Medical Association says there is an urgent need to investigate the issue.